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Azcárraga Aranegui G, Campos Sañudo JA, Benejam Cual J, Ballestero Diego R. The state of robotic surgery in Spain: Results of a national survey on robotic surgery. Scott Med J 2024; 69:102-107. [PMID: 39569533 DOI: 10.1177/00369330241300376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
BACKGROUND AND AIMS To assess the present state of robotic surgery and the surgical approaches employed by urology departments utilizing robotic systems in Spain. METHODS AND RESULTS An email invitation was sent to heads of urology departments in public and private hospitals with surgical robots. A 78-question online questionnaire was distributed, and data were collected over 3 months. Of 82 invitations, 57.31% responded, mostly male (95.7%) urologists over 50 years old, with 77.8% having more than 20 years of practice. About 45.7% worked in both public and private settings. Most units use robots 1-3 days per week, with 56.1% of these units having 1-3 surgeons trained. 92.3% of respondents had laparoscopic experience, and 71.1% received robotic surgery training from the robot company. Radical prostatectomy, pyeloplasty, and cystectomy are mainly performed robotically, while other surgeries vary in approach. CONCLUSION Robotic surgery has been firmly established in Spain, although the percentage of surgeries in robotic units remains low. Radical prostatectomy, pyeloplasty, and radical cystectomy with diversion are the most commonly performed techniques using robotic approaches.
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Takayasu K, Yoshida K, Matsuzaki T, Mishima T, Kinoshita H. Development and evaluation of vesicourethral anastomosis bench-top model for measurement of traction force on urethra in robotic surgery. Surg Endosc 2024; 38:5220-5227. [PMID: 39046496 DOI: 10.1007/s00464-024-11080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE In vesicourethral anastomosis (VUA), which is part of robot-assisted radical prostatectomy, surgeons must proceed carefully to avoid urethral damage. We developed and evaluated a VUA bench-top model that can measure the traction force on the urethra during robotic surgery. MATERIALS AND METHODS The VUA model included the urethra, bladder, pelvic bones, and a small force sensor that was capable of measuring the traction force on the urethra. Eight skilled and eight novice urologists performed a VUA task in robotic surgery. The skilled surgeons assessed the model's realism and usefulness as a training tool using a 5-point Likert scale. The evaluation items [task time, maximum force, force volume, and length of time that specific excessive forces were applied to the urethra (2, 3, 4, and ≥ 5 N)] were compared between the skilled and novice surgeons using the Mann-Whitney U test. Measurements were conducted in four directions with respect to the maximum force on the urethra: 11-1, 2-4, 5-7, and 8-10 o'clock. RESULTS The quality of the model was scored 3.7 to 4.9 points for all 16 items in 4 domains except for "Usefulness compared with animal models." There were differences in the task time and almost all force parameters between the skilled and novice surgeons. CONCLUSION We developed a relatively high-quality VUA bench-top model that measures traction force on the urethra, and we have revealed differences in the forces of action on the urethra in two groups of surgeons with different skill levels.
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Affiliation(s)
- Kenta Takayasu
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
| | - Kenji Yoshida
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Tomoaki Matsuzaki
- Department of Urology and Andrology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Takao Mishima
- Department of Urology and Andrology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Noshiro H, Ide T, Nomura A, Yoda Y, Hiraki M, Manabe T. Introduction of a new surgical robot platform "hinotori™" in an institution with established da Vinci surgery™ for digestive organ operations. Surg Endosc 2024; 38:3929-3939. [PMID: 38839604 DOI: 10.1007/s00464-024-10918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/05/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND New platforms for robotic surgery have recently become available for clinical use; however, information on the introduction of new surgical robotic platforms compared with the da Vinci™ surgical system is lacking. In this study, we retrospectively determined the safe introduction of the new "hinotori™" surgical robot in an institution with established da Vinci surgery using four representative digestive organ operations. METHODS Sixty-one patients underwent robotic esophageal, gastric, rectal, and pancreatic operations using the hinotori system in our department in 2023. Among these, 22 patients with McKeown esophagectomy, 12 with distal gastrectomy, 11 with high- and low-anterior resection of the rectum, and eight with distal pancreatectomy procedures performed by hinotori were compared with historical controls treated using da Vinci surgery. RESULTS The console (cockpit) operation time for distal gastrectomy and rectal surgery was shorter in the hinotori group compared with the da Vinci procedure, and there were no significant differences in the console times for the other two operations. Other surgical results were almost similar between the two robot surgical groups. Notably, the console times for hinotori surgeries showed no significant learning curves, determined by the cumulative sum method, for any of the operations, with similar values to the late phase of da Vinci surgery. CONCLUSIONS This study suggests that no additional learning curve might be required to achieve proficient surgical outcomes using the new hinotori surgical robotic platform, compared with the established da Vinci surgery.
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Affiliation(s)
- Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Akinari Nomura
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Yukie Yoda
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masatsugu Hiraki
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tatsuya Manabe
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Miyake H, Fujisawa M. Early experience and future prospects regarding use of newly developed surgical robot system, hinotori, in the field of urologic cancer surgery. Int J Clin Oncol 2024; 29:640-646. [PMID: 38625439 PMCID: PMC11130061 DOI: 10.1007/s10147-024-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
In the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical approach in the majority of major surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. Of these, hinotori, the first made-in-Japan robotic system, is characterized by various unique and attractive features different from the existing system, and the use of this system has gradually increased mainly in urologic cancer surgeries, including radical prostatectomy, partial nephrectomy, radical nephrectomy, and radical nephroureterectomy. This review initially describes detailed characteristics of hinotori, then summarizes the early experience with urologic cancer surgeries using hinotori at our institution, and finally discusses the future prospects of robotic surgery using hinotori, considering problems associated with the use of this robotic system.
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Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Sasaki Y, Takahashi M, Shiozaki K, Hori K, Kadoriku F, Daizumoto K, Tomida R, Ueno Y, Kusuhara Y, Fukawa T, Yamaguchi K, Yamamoto Y, Tomita K, Sairyo K, Kanayama H. The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot-assisted surgery. Asian J Endosc Surg 2024; 17:e13254. [PMID: 37837342 DOI: 10.1111/ases.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
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Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Katsuhito Hori
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Fumiya Kadoriku
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koichi Tomita
- Department of Anatomy and Developmental Neurobiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Otsuka A, Fujisawa M, Miyake H. Robot-assisted radical nephrectomy using novel surgical robot platform, hinotori: Report of initial series of 13 cases. Int J Urol 2023; 30:1175-1179. [PMID: 37654155 DOI: 10.1111/iju.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES The aims of the present study were to describe the perioperative findings of the first series of patients undergoing robot-assisted radical nephrectomy (RARN) with a newly launched platform, the hinotori surgical robot system, and compare the findings with a similar set receiving RARN with the existing system, da Vinci. METHODS This study included 34 patients, consisting of 13 and 21 undergoing RARN using the hinotori and da Vinci robotic systems, respectively. As a rule, RARN was performed via an intraperitoneal approach employing 3 robotic arms, irrespective of the robotic systems. RESULTS In the hinotori group, the median age, body mass index and tumor diameter were 65 years, 23.3 kg/m2 and 50 mm, respectively. All surgical procedures with hinotori could be completed by a purely robotic approach. In the hinotori group, the median operative time, time using the robotic system, estimated blood loss and length of hospital stay were 157, 83 min, 11 mL and 6 days, respectively, and major perioperative complications did not occur. In this group, 3, 1 and 9 patients were pathologically diagnosed with pT1a, pT1b and pT3a tumors, respectively. No significant differences in baseline characteristics were noted between the hinotori and da Vinci groups, and there were also no significant differences in perioperative findings between them. CONCLUSIONS Despite a case series with a small sample size, this is the first report evaluating RARN using the hinotori surgical robot system, which could be safely conducted and achieved perioperative outcomes similar to that using the da Vinci system.
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Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Okullo A, Saad J, Ashrafi D, Bagheri N, Haxhimolla H. Outcomes of robotic modified Freyer's prostatectomy in an Australian patient cohort. BJUI COMPASS 2023; 4:729-737. [PMID: 37818021 PMCID: PMC10560623 DOI: 10.1002/bco2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction The study aims to demonstrate the feasibility, safety and efficacy of robotic simple prostatectomy (RSP) using the modified Freyer's approach in an Australian patient cohort. Although RSP is performed in several Australian centres, there is a paucity of published Australian data. Methods We reviewed prospectively collected perioperative and outcomes data for patients who underwent a robotic modified Freyer's prostatectomy (RMFP) from June 2019 to March 2022. Statistics were completed using SPSS statistics v27.0 and reported as mean and range with a p value of <0.05 considered statistically significant. Results There were 27 patients who underwent RMFP over the study period with a mean age of 67 years and prostate volume of 159.74 cc (100-275). The mean console time was 168 min (122-211), blood loss of 233 ml (50-600) and average length of hospital stay of 3.8 days (3-8). The preoperative versus postoperative outcome means were as follows: serum prostate-specific antigen was 9.69 versus 1.2 ng/mL, IPPS score was 17.1 versus 1.25, quality of life (QOL) score 3.4 versus 0.4, postvoid residual volume: 223.6 versus 55.9 ml, Q-max 7.86 versus 29.6 ml/s. These were all statistically significant (p < 0.001). The mean weight of resected tissue was 74 g (43-206) with 25 patients having benign histopathology and two being diagnosed with prostate cancer (Gleason 3 + 3 = 6 and 3 + 4 = 7). No patients returned to theatre or required a blood transfusion. Conclusions Data from our patient cohort demonstrate the feasibility, safety and efficacy of RMFP for benign prostatic hyperplasia in an Australian patient cohort. Our outcomes compare favourably with published studies on RSP.
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Affiliation(s)
- Alfin Okullo
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Jeremy Saad
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Darius Ashrafi
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Nasser Bagheri
- The Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Hodo Haxhimolla
- The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
- National Capital Private HospitalCanberraAustralian Capital TerritoryAustralia
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Roy N, Alessandro CJ, Ibelli TJ, Akhavan AA, Sharaf JM, Rabinovitch D, Henderson PW, Yao A. The Expanding Utility of Robotic-Assisted Flap Harvest in Autologous Breast Reconstruction: A Systematic Review. J Clin Med 2023; 12:4951. [PMID: 37568353 PMCID: PMC10419897 DOI: 10.3390/jcm12154951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/13/2023] Open
Abstract
The expansion of robotic surgery has led to developments in robotic-assisted breast reconstruction techniques. Specifically, robotic flap harvest is being evaluated to help maximize operative reliability and reduce donor site morbidity without compromising flap success. Many publications are feasibility studies or technical descriptions; few cohort analyses exist. This systematic review aims to characterize trends in robotic autologous breast reconstruction and provide a summative analysis of their results. A systematic review was conducted using PubMed, Medline, Scopus, and Web of Science to evaluate robot use in breast reconstruction. Studies dated from 2006 to 2022 were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text, peer-reviewed, English-language, and human subject studies were included. Non-breast reconstruction articles, commentary, expert opinion, editor's letter, and duplicate studies were excluded. A total of 17 full-text articles were analyzed. The two robotic breast procedures identified were the deep inferior epigastric perforator (DIEP) and the latissimus dorsi (LD) flap. Results showed comparable complication rates and increased operative times compared to NSQIP data on their corresponding open techniques. Additional findings reported in studies included patient reported outcomes, incision lengths, and downward trends in operative time with consecutive procedures. The available data in the literature confirms that robotic surgery is a promising alternative to traditional open methods of breast reconstruction following mastectomy.
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Affiliation(s)
- Nikita Roy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
| | | | - Taylor J. Ibelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
| | - Arya A. Akhavan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
| | - Jake M. Sharaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
| | - David Rabinovitch
- The American Medical Program, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Peter W. Henderson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
| | - Alice Yao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.R.); (T.J.I.); (A.A.A.); (J.M.S.); (P.W.H.)
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Siech C, Fassbach M, Neutzer M, Beverungen H. [Status quo of urological residency training in Germany-a strengths, weaknesses, opportunities, and threats (SWOT) analysis]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02131-3. [PMID: 37405422 DOI: 10.1007/s00120-023-02131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Urological residency training is a decisive step on the urological career path. The aim of this review is to develop strategies and approaches to actively shape, improve and further develop urological residency training. METHODS With the help of a strengths, weaknesses, opportunities, and threats (SWOT) analysis, the status quo of urological residency training in Germany is analyzed in a structured manner. RESULTS Strengths of urological residency training incorporate the attractiveness of the specialty itself, and the residency training curriculum in urology ("Weiterbildungscurriculum Urologie", WECU), including the networking of inpatient and outpatient training and accompanying internal and external further training. The German Society of Residents in Urology (GeSRU) also provides a networking platform for residents. Weaknesses include country-specific differences and a lack of checkpoints during residency training. Opportunities for urological continuing education arise from freelance work, digitalization, and technical and medical progress. In contrast, the aftermath of the coronavirus disease 2019 (COVID 19) pandemic, with still limited staff and surgical capacities, an increased psychosocial workload, and the rising number of outpatient treatments in urology pose threats for urological residency programs. CONCLUSIONS With the help of a SWOT analysis, factors for the further development of urological residency training can be identified. In order to provide high-quality residency training in the future, strengths and opportunities should be consolidated and weaknesses and threats should be addressed at an early stage.
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Affiliation(s)
- Carolin Siech
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Mira Fassbach
- Klinik Urologie, urologische Onkologie und Kinderurologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - Maike Neutzer
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer Krefeld GmbH, Krefeld, Deutschland
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Miyake H, Motoyama D, Matsushita Y, Watanabe H, Tamura K, Otsuka A, Fujisawa M. Initial experience of robot-assisted partial nephrectomy using hinotori surgical robot system: Single institutional prospective assessment of perioperative outcomes in 30 cases. J Endourol 2023; 37:531-534. [PMID: 36800894 DOI: 10.1089/end.2022.0775] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
INTRODUCTION Innovation of robotic surgery is still actively growing, and various novel robotic systems are in the process of development. The objective of this study was to assess the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) using the hinotori surgical robot system, a recently developed robot-assisted surgical platform, for patients with small renal tumors. METHODS This study prospectively included a total of 30 consecutive patients who were diagnosed with small renal tumors and subsequently underwent RAPN using hinotori between April and November 2022. Major perioperative outcomes in these 30 patients were comprehensively analyzed. RESULTS The median tumor size and R.E.N.A.L. nephrometry score in the 30 patients were 28 mm and 8, respectively. Of these 30, 25 and 5 received RAPN by intra- and retro-peritoneal approaches, respectively. RAPN could be completed in all 30 patients without conversion to nephrectomy or open surgery. The median operative time, time using hinotori and warm ischemia time were 179, 106 and 13 minutes, respectively. No patient was diagnosed with a positive surgical margin or experienced major perioperative complications, corresponding to Clavien-Dindo 3≤. Achievements of trifecta and margin, ischemia and complications (MIC) outcomes in this series were 100 and 96.7%, respectively, and median changes in the estimated glomerular filtration rate 1 day and 1 month after RAPN were -20.9 and -11.7%, respectively. CONCLUSIONS This is the first study focusing on RAPN using hinotori, which showed favorable perioperative outcomes, considering the findings of trifecta and MIC. Although it will be necessary to investigate the long-term effects of RAPN using hinotori on oncological and functional outcomes, the present findings strongly suggest that the hinotori surgical robot system could be safely applied to RAPN for patients with small renal tumors.
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Affiliation(s)
- Hideaki Miyake
- Hamamatsu University School of Medicine, 12793, Urology, Hamamatsu, Shizuoka, Japan;
| | - Daisuke Motoyama
- Hamamatsu University School of Medicine, 12793, Urology, Hamamatsu, Japan.,Hamamatsu University School of Medicine, 12793, Developed Studies for Advanced Robotic Surgery, Hamamatsu, Shizuoka, Japan;
| | - Yuto Matsushita
- Hamamatsu University School of Medicine, 12793, Urology, 1-20-1, Handayama, HIgashiku, Hamamatsu, Shizuoka, Japan, 433-3192;
| | - Hiromitsu Watanabe
- Hamamatsu University School of Medicine, 12793, Urology, Hamamatsu, Shizuoka, Japan;
| | - Keita Tamura
- Hamamatsu University School of Medicine, 12793, Urology, Hamamatsu, Shizuoka, Japan;
| | - Atsushi Otsuka
- Hamamatsu University School of Medicine, 12793, Urology, Hamamatsu, Shizuoka, Japan;
| | - Masato Fujisawa
- Kobe University Graduate School of Medicine School of Medicine, 38303, Urology, Kobe, Hyogo, Japan;
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Ronaghi MH. Toward a model for assessing smart hospital readiness within the Industry 4.0 paradigm. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-09-2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The fourth industrial revolution and digital transformation have caused paradigm changes in the procedures of goods production and services through disruptive technologies, and they have formed new methods for business models. Health and medicine fields have been under the effect of these technology advancements. The concept of smart hospital is formed according to these technological transformations. The aim of this research, other than explanation of smart hospital components, is to present a model for evaluating a hospital readiness for becoming a smart hospital.
Design/methodology/approach
This research is an applied one, and has been carried out in three phases and according to design science research. Based on the previous studies, in the first phase, the components and technologies effecting a smart hospital are recognized. In the second phase, the extracted components are prioritized using type-2 fuzzy analytic hierarchical process based on the opinion of experts; later, the readiness model is designed. In the third phase, the presented model would be tested in a hospital.
Findings
The research results showed that the technologies of internet of things, robotics, artificial intelligence, radio-frequency identification as well as augmented and virtual reality had the most prominence in a smart hospital.
Originality/value
The innovation and originality of the forthcoming research is to explain the concept of smart hospital, to rank its components and to provide a model for evaluating the readiness of smart hospital. Contribution of this research in terms of theory explains the concept of smart hospital and in terms of application presents a model for assessing the readiness of smart hospitals.
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Numakura K, Kobayashi M, Koizumi A, Kashima S, Yamamoto R, Nara T, Saito M, Narita S, Inoue T, Habuchi T. Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon's experience. World J Surg Oncol 2022; 20:202. [PMID: 35701769 PMCID: PMC9199197 DOI: 10.1186/s12957-022-02669-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Warm ischemia time (WIT) is a primary concern for robot-assisted laparoscopic partial nephrectomy (RALPN) patients because longer WIT is significantly associated with postoperative deteriorating kidney function. Tumor complexity, determined by the RENAL nephrometry score (RENAL score), can help predict surgical outcomes, but it is unclear what RENAL score and clinical factors affect WIT. This study explored the clinical factors predicting long WIT in experienced surgeon to RALPN. MATERIALS AND METHODS In our institute, 174 RALPNs were performed between November 2013 and February 2021, of which 114 were performed by a single surgeon and included in this study. Clinical staging and the total RENAL score were determined based on preoperative CT scans. The cases were divided into three groups based on experience: period 1: 1-38, period 2: 39-76, and period 3: 77-114. The clinical factors associated with longer WIT were analyzed per period. RESULTS The overall median tumor diameter was 32 mm, and one patient had a positive surgical margin, but there were no cancer-related deaths. In total, there were 18 complications (15.8%). Periods 2 and 3 had larger tumor diameters (p < 0.01) and worse preoperative kidney function (p = 0.029) than period 1. A RENAL L-component score of 3 was associated with longer WIT in period 3 (odds ratio: 3.900; 95% confidence interval: 1.004-15.276; p = 0.044), but the tumor diameter and the total RENAL score were not. CONCLUSIONS A large tumor in the central lesion indicated by the RENAL L-component score was associated with increased WIT in RALPN.
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Affiliation(s)
- Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Atsushi Koizumi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Soki Kashima
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takamitsu Inoue
- Department of Urology, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, 286-0124, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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13
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Hardon SF, Kooijmans A, Horeman R, van der Elst M, Bloemendaal ALA, Horeman T. Validation of the portable virtual reality training system for robotic surgery (PoLaRS): a randomized controlled trial. Surg Endosc 2021; 36:5282-5292. [PMID: 34873652 PMCID: PMC9160149 DOI: 10.1007/s00464-021-08906-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed. METHODS The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical's da Vinci Skills Simulator (dVSS) and to establish face- and construct validity. Medical students were divided into two groups; the test group (n = 18) performing tasks on PoLaRS and dVSS, and the control group (n = 20) only performing tasks on the dVSS. The performance parameters were Time, Path length, and the number of collisions. Afterwards, the test group participants filled in a questionnaire regarding both systems. RESULTS A total of 528 trials executed by 38 participants were measured and included for analyses. The test group significantly improved in Time, Path Length and Collisions during the PoLaRS test phase (P ≤ 0.028). No differences was found between the test group and the control group in the dVSS performances during the post-test phase. Learning curves showed similar shapes between both systems, and between both groups. Participants recognized the potential benefits of simulation training on the PoLaRS system. CONCLUSIONS Robotic surgical skills improved during training with PoLaRS. This shows the potential of PoLaRS to become an affordable alternative to current surgical robot simulators. Validation with similar tasks and different expert levels is needed before implementing the training system into robotic training curricula.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Anton Kooijmans
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Roel Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Maarten van der Elst
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.,Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, The Netherlands
| | | | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands. .,Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, The Netherlands.
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14
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Al Gosaibi A, Al Mulhim A, Al Sadhan M, Alkharji A, Rajih E, Alenizi AM. Robotic-assisted excision of a juxta renal retroperitoneal schwannoma. Urol Ann 2021; 13:316-319. [PMID: 34421273 PMCID: PMC8343282 DOI: 10.4103/ua.ua_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Retroperitoneal schwannoma is a rare benign tumor of the peripheral nerve Schwann sheath. We, herein, report the case of a 74-year-old woman who presented with vague abdominal pain. Computed tomography imaging revealed a retroperitoneal mass that is medial to the right kidney. The patient underwent robotic excision of the tumor with the pathology revealing schwannoma. We report this case due to the scarcity of this disease entity, especially at this location and to emphasize the indication and value of robotic technology in different pathological processes retroperitoneally.
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Affiliation(s)
| | | | - Meshaal Al Sadhan
- Division of Urology, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Ali Alkharji
- Division of Urology, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Emad Rajih
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Abdullah M Alenizi
- Division of Urology, Security Forces Hospital Program, Riyadh, Saudi Arabia
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15
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Uddin MM, Varley R, Napier-Hemy RD. Our experience in laparoscopic ureterolysis and omental wrapping as a definitive surgical management of ureteric obstruction related to retroperitoneal fibrosis. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211022215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction and Objectives: Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory disease and a cause of ureteric obstruction that leads to obstructive uropathy. Although the mainstay of RPF treatment is medical, ureterolysis becomes a necessity if medical treatment fails or if patients are unable to tolerate side effects of conservative/medical management, including those of ureteric stents. We aimed to investigate our experience of laparoscopic ureterolysis (LU) and omental wrapping as a definitive surgical treatment for RPF. Patients and methods: We conducted a retrospective analysis of 17 patients who underwent LU between September 2009 and October 2018 in a single institution. Mode of presentation, investigation and interventions were reviewed. Outcome measures were stent or nephrostomy-free rates, post-ureterolysis change in estimated glomerular filtration rate (eGFR), operative time, estimated blood loss, length of hospital stay, complications and need for additional procedures. MAG3 renography was performed to assess ureteral patency. Results: Among 17 patients, a total of 23 LU procedures were performed in 20 operative sessions. Median (IQR) length of hospital stay was 4 (2–6) days. Median length of follow-up was 23.5 months (range 4–92 months), where 14 patients completed at least 15 months of follow-up. All patients were either stent ( n=9) or nephrostomy ( n=8) dependent before ureterolysis. Some 82.4% patients ( n=14) remain stent/nephrostomy free after LU. Renal function remains stable after ureterolysis with a median (IQR) change in eGFR at latest follow-up of: +7.5 (−8 to +23), ( P=0.74). Conclusions: LU is safe and effective at halting decline in renal dysfunction secondary to RPF. It has reliably avoided internal or external ureteric drainage in most patients. Consideration should be given to early referral to a specialised centre for ureterolysis in the context of multi-disciplinary management of benign RPF, to preservation of renal function and to render patients stent or nephrostomy free. Level of Evidence: 4 (case series).
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Affiliation(s)
- MM Uddin
- Department of Urology, Manchester Royal Infirmary, UK
| | - R Varley
- Department of Urology, Manchester Royal Infirmary, UK
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16
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Matsuda Y, Narita S, Okubo T, Mitsuzuka K, Hatakeyama S, Koizumi A, Koie T, Kawamura S, Tochigi T, Ito A, Oyama C, Arai Y, Habuchi T. Impact of Nerve-Sparing Status on Positive Surgical Margin Location and Biochemical Recurrence in Patients with Prostate Cancer Post Radical Prostatectomy. Ann Surg Oncol 2021; 28:5341-5348. [PMID: 34109511 DOI: 10.1245/s10434-021-10281-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE This study was designed to assess the relationship between nerve-sparing (NS) status, positive surgical margin (PSM) location, and biochemical recurrence (BCR) based on a multicenter, radical prostatectomy (RP) database. METHODS We retrospectively reviewed data from 726 patients who underwent RP without any neoadjuvant or adjuvant treatment between 2010 and 2014. We statistically assessed the impact of NS sides on PSM location and BCR. RESULTS PSM rates were 21.9% in the 726 patients studied, 13.2% in patients with ≤pT2, and 46.8% in patients with ≥pT3. Regarding PSM locations, the anterior-apex (AA) was the most common site for PSM (43.3%). After adjusting for confounding factors, bilateral nerve sparing (BNS) had a significantly higher odds ratio of PSM than the absence of NS did (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.85-4.99). In the UNS RP in patients with ≤pT2, non-AA PSM on the non-NS side was significantly higher than that on the NS side (92.9% vs. 45.5%, p = 0.009). In all patients, 5.8% experienced BCR during a median follow-up of 43.5 months. PSM was significantly associated with BCR-free survival in patients with ≤pT2 (p = 0.013), but not in patients with ≥pT3 (p = 0.185). Non-AA PSM at the non-NS side was an independent risk factor for BCR (hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.12-5.85), whereas AA PSMs, including NS/non-NS sides and non-AA PSM at the NS side, were not associated with BCR-free survival. CONCLUSIONS Avoidance of non-AA PSM on the non-NS side may be rather important for maintaining BCR-free survival after RP.
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Affiliation(s)
- Yoshinori Matsuda
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita, Japan. .,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan.
| | - Teppei Okubo
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Atsushi Koizumi
- Department of Urology, Akita University School of Medicine, Akita, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Takuya Koie
- Department of Urology, Gifu University School of Medicine, Gifu, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Sadafumi Kawamura
- Department of Urology, Miyagi Cancer Center, Miyagi, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Tatsuo Tochigi
- Department of Urology, Miyagi Cancer Center, Miyagi, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Chikara Oyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Yoichi Arai
- Department of Urology, Miyagi Cancer Center, Miyagi, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan.,Michinoku Japan Urological Cancer Study Group (MJUCSG), Sendai, Japan
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17
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Naik R, Mandal I, Hampson A, Casey R, Vasdev N. A Comparison of Urology Training Across Five Major English-Speaking Countries. Curr Urol 2020; 14:14-21. [PMID: 32398992 DOI: 10.1159/000499265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Urology is a rapidly evolving specialty, although wide variations exist between training programs in different countries. We aimed to compare the status of urology training in 5 English-speaking countries. Materials and Methods Features compared include the training pathway structure, training requirements, competition levels and the process of moving country for international medical graduates. Results Length of training varied considerably across countries, ranging from 5 years in the USA and Canada, to 7 years in Australia and New Zealand and 9 years in the UK. Ease of entering urology training for international medical graduates also varies, with the UK relatively easier compared to other countries. All countries encourage participation in research during training as well as completion of non-urology and urology specific surgical examinations. Conclusion Following the Royal College of Surgeons Improving Surgical Training report, it is vital that the UK incorporates optimal elements of international programs in order to provide the best standards for trainees and world-class care in urology.
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Affiliation(s)
- Rishi Naik
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | - Indrajeet Mandal
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | | | - Rowan Casey
- Department of Urology, Colchester General Hospital, Colchester, UK
| | - Nikhil Vasdev
- UCL Medical School, Faculty of Medical Sciences, University College London, London
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18
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Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model. J Robot Surg 2020; 15:25-30. [PMID: 32266666 DOI: 10.1007/s11701-020-01065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Pediatric robot-assisted surgery is technically challenging, but it is becoming the most desirable approach for most of the pediatric urological abdominal surgical procedures. Distance between ports has been adopted based on adult surgery experience. Currently, there is scarce information and literature about effective trocar position and distance between ports for highly complex pediatric multiquadrant surgery. The aim of this study is to evaluate the most effective way of port placement for pediatric multiquadrant robot-assisted surgery using an inanimate model. Two inanimate models simulating the abdominal area of an older infant were created: model (1) 33.3 × 29.6 × 11.5 cm and model (2) 15 × 13 × 8 cm. A simulation of a robot-assisted laparoscopic Mitrofanoff procedure was performed in both models simulating appendix procurement and subsequent anastomosis to the bladder dome. In the first model, the simulation was performed in two ways: (a) adult trocars were placed with a distance of 4 cm between them and placed longitudinally and (b) ports were placed by triangulating the camera 2 cm in a cephalic fashion. In the second model, (a) scenario was used as described above (c) single port crossing the arms. Volume of the first model was 11,335.32 cm3. Simulation (b) reached higher percentage of volumes without arm clash (30.19 vs. 41.92%, p = 0.021). In the second model with a volume of 1560 cm3, simulation (a) reached a volume percentage of 65.15% without arm clash and allowing the multiquadrant advance, while simulation (c) could not be performed due to arm collision and the inability to advance and see the four quadrants. Triangulation and increasing the distance away from the point of interest improve intracorporeal EWS for multiquadrant complex pediatric surgery.
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19
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Enikeev M, Gahan J, Yossepowitch O, Rapoport L, Grigoryan V, Abdusalamov A, Lobanov M, Chuvalov L, Taratkin M, Ali S, Gaas M, Enikeev D, Glybochko P. Extracorporeal ureter handling during laparoscopic pyeloplasty: tips and tricks for beginners. Cent European J Urol 2020; 72:413-417. [PMID: 32015913 PMCID: PMC6979559 DOI: 10.5173/ceju.2019.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Laparoscopic preparation of the ureter is a challenging part of upper urinary tract reconstruction, due to limited depth perception provided by the camera and lack of wristed motion of most laparoscopic instruments needed for adequate spatulation and scar tissue removal. One solution has been to perform the more difficult portions of the surgery in an extracorporeal manner. A hybrid intracorporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique. Material and methods This retrospective study included 100 patients with primary ureteropelvic junction obstruction, who underwent laparoscopic pyeloplasty from 2014 to 2017. The patients were stratified into 2 groups: those who underwent conventional laparoscopic surgery and those who were managed with the hybrid approach. For the hybrid approach, externalizing the ureter to skin level required additional mobilization of the upper urinary tract. Results A total of 47 patients underwent conventional laparoscopic pyeloplasty and 53 - hybrid surgery. The maximum body mass index was 32. The hybrid approach was 8.5 minutes shorter compared to the conventional approach (p <0.001). No complications higher than Clavien-Dindo IIIb (n = 2) were observed (in both groups). Complete success (the resolution of pain and/or hydronephrosis) was observed in 92.5% in the hybrid group and in 95.7% in the conventional treatment group. Conclusions Hybrid pyeloplasty may be considered safe and effective. It has the advantage of making the surgery less challenging and time-consuming while offering improved precision. The advantages of the technique are particularly apparent during training. This technique can be recommended in the learning process of the surgeon.
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Affiliation(s)
- Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jeffrey Gahan
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vagarshak Grigoryan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Mikhail Lobanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Chuvalov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Stanislav Ali
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Margarita Gaas
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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20
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Busch C, Nakadate R, Uemura M, Obata S, Jimbo T, Hashizume M. Objective assessment of robotic suturing skills with a new computerized system: A step forward in the training of robotic surgeons. Asian J Endosc Surg 2019; 12:388-395. [PMID: 30461209 DOI: 10.1111/ases.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/05/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this study was to assess robot-assisted suturing skills on a laparoscopic intestinal anastomosis model by using a novel computerized objective assessment system. METHODS This study compared the suturing skills of 13 surgically naïve participants on an artificial intestinal anastomosis model that mimics real tissue. Each examinee sutured using da Vinci robot assistance under 2-D and 3-D visualization and with conventional laparoscopy (CL). Pressure-measuring and image-processing devices were employed to quantitatively evaluate suturing skills. Five unique criteria were used to evaluate the skills of participants. RESULTS Suturing under 3-D visualization (P < 0.01) and with CL (P < 0.05) were significantly faster than under 2-D visualization. Sutures placed under 3-D (P < 0.05) and 2-D (P < 0.01) visualization had significantly better suture tension than those placed with CL, which did not meet acceptable values for suture tension. Sutures placed with CL had significantly better air pressure leakage than those placed under 2-D visualization (P < 0.05), which did not meet acceptable values for air pressure leakage and wound opening area. One participants failed to achieve full-thickness sutures with 2-D, two participants with CL, and one participant with 3-D. CONCLUSION Using 3-D vision is necessary for complex maneuvering during robot-assisted minimally invasive surgery. Our quantitative assessment system is useful for evaluating the skill acquisition of surgeon-trainees undergoing robotic surgery training.
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Affiliation(s)
- Caleb Busch
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan
| | - Munenori Uemura
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Obata
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Jimbo
- Department of Pediatric Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Makoto Hashizume
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.,Kitakyushu Chuou Hospital, Kitakyushu, Japan
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21
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Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15770. [PMID: 31145297 PMCID: PMC6709105 DOI: 10.1097/md.0000000000015770] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies. METHODS A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software. RESULTS Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost. CONCLUSION RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes.
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Affiliation(s)
| | - Zhenyu Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minfeng Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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22
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Pal RP, Koupparis AJ. Expanding the indications of robotic surgery in urology: A systematic review of the literature. Arab J Urol 2018; 16:270-284. [PMID: 30147957 PMCID: PMC6105341 DOI: 10.1016/j.aju.2018.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives To evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities. Methods A systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis. Results In all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques. Conclusion Emerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.
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Key Words
- (L)(R)RP, (laparoscopic)(retropubic)radical prostatectomy
- (L)(RA) PN, (laparoscopic)(robot-assisted) partial nephrectomy
- (L-)(O-)(R-) RPLND, (laparoscopic)(open)(robot-assisted) retroperitoneal lymph node dissection
- (O)(L)(RA)SP, (open)(laparoscopic)(robot-assisted)simple prostatectomy
- (RA)RC, (robot-assisted) radical cystectomy
- (S)UI, (stress) urinary incontinence
- (s)RALP, (salvage)robot-assisted laparoscopic prostatectomy
- AUS, artificial urinary sphincter
- HoLEP, holmium laser enucleation of the prostate
- ICUD, intracorporeal urinary diversion
- LOS, length of hospital stay
- MIS, minimally invasive surgery
- PCNL, percutaneous nephrolithotomy
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAI, robot-assisted augmentation ileocystoplasty
- RAS, robot-assisted surgery
- RCT, randomised controlled trial
- RNL, robot-assisted nephrolithotomy
- RPL, robot-assisted pyelolithotomy
- Robot-assisted surgery
- Robotic surgery
- Urology
- sRRP, salvage RRP
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Affiliation(s)
- Raj P Pal
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Abstract
Twenty years after it was introduced, robotic surgery has become more commonplace in urology – we examine its current uses and controversies
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