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Basile G, Gallioli A, Diana P, Gallagher A, Larcher A, Graefen M, Harke N, Traxer O, Tilki D, Van Der Poel H, Emiliani E, Angerri O, Wagner C, Montorsi F, Wiklund P, Somani B, Buffi N, Mottrie A, Liatsikos E, Breda A. Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review. Eur Urol 2024; 86:130-145. [PMID: 38644144 DOI: 10.1016/j.eururo.2024.04.008] [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: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways. METHODS We systematically reviewed the literature using PubMed/Medline, Embase, and Web of Science databases. The validity of each training model was assessed. The methodological quality of studies on metrics and curricula was graded using the MERSQI scale. The level of evidence (LoE) and level of recommendation for surgical curricula were awarded using the educational Oxford Centre for Evidence-Based Medicine classification. KEY FINDINGS AND LIMITATIONS A total of 75 studies were identified. Many simulators have been developed to aid trainees in mastering skills required for both robotic and endourology procedures, but only four demonstrated predictive validity. For assessment of trainee proficiency, we identified 18 in robotics training and six in endourology training; however, the majority are Likert-type scales. Although proficiency-based progression (PBP) curricula demonstrated superior outcomes to traditional training in preclinical settings, only four of six (67%) in robotics and three of nine (33%) in endourology are PBP-based. Among these, the Fundamentals of Robotic Surgery and the SIMULATE curricula have the highest LoE (level 1b). The lack of a quantitative synthesis is the main limitation of our study. CONCLUSIONS AND CLINICAL IMPLICATIONS Training curricula that integrate simulators and PBP methodology have been introduced to standardize trainee outcomes in robotics and endourology. However, evidence regarding their educational impact remains restricted to preclinical studies. Efforts should be made to expand these training programs to different surgical procedures and assess their clinical impact.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Anthony Gallagher
- Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Coleraine, UK; ORSI Academy, Melle, Belgium
| | | | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Olivier Traxer
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | | | - Peter Wiklund
- Icahn School of Medicine, Mount Sinai Health System New York City, NY, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Nicolò Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, OLV Hospital, Aalst, Belgium
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
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Li Y, Reed A, Kavoussi N, Wu JY. Eye gaze metrics for skill assessment and feedback in kidney stone surgery. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02901-6. [PMID: 37202714 DOI: 10.1007/s11548-023-02901-6] [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: 02/16/2023] [Accepted: 03/31/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Surgical skill assessment is essential for safe operations. In endoscopic kidney stone surgery, surgeons must perform a highly skill-dependent mental mapping from the pre-operative scan to the intraoperative endoscope image. Poor mental mapping can lead to incomplete exploration of the kidney and high reoperation rates. Yet there are few objective ways to evaluate competency. We propose to use unobtrusive eye-gaze measurements in the task space to evaluate skill and provide feedback. METHODS We capture the surgeons' eye gaze on the surgical monitor with the Microsoft Hololens 2. To enable stable and accurate gaze detection, we develop a calibration algorithm to refine the eye tracking of the Hololens. In addition, we use a QR code to locate the eye gaze on the surgical monitor. We then run a user study with three expert and three novice surgeons. Each surgeon is tasked to locate three needles representing kidney stones in three different kidney phantoms. RESULTS We find that experts have more focused gaze patterns. They complete the task faster, have smaller total gaze area, and the gaze fewer times outside the area of interest. While fixation to non-fixation ratio did not show significant difference in our findings, tracking the ratio over time shows different patterns between novices and experts. CONCLUSION We show that a non-negligible difference holds between novice and expert surgeons' gaze metrics in kidney stone identification in phantoms. Expert surgeons demonstrate more targeted gaze throughout a trial, indicating their higher level of proficiency. To improve the skill acquisition process for novice surgeons, we suggest providing sub-task specific feedback. This approach presents an objective and non-invasive method to assess surgical competence.
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Affiliation(s)
- Yizhou Li
- Department of Computer Science, Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN, 37240, USA.
| | - Amy Reed
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Nicholas Kavoussi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Jie Ying Wu
- Department of Computer Science, Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN, 37240, USA.
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Jones P, Pietropaolo A, Chew BH, Somani BK. Atlas of scoring systems, grading tools and nomograms in Endourology: A comprehensive overview from The TOWER Endourological Society research group. J Endourol 2021; 35:1863-1882. [PMID: 33878937 DOI: 10.1089/end.2021.0124] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems, grading tools and nomograms in Endourology is provided in this paper. METHODS A comprehensive search of world literature was performed to identify nomograms, grading systems and classification tools in endourology related to KSD. Each of these were reviewed by the authors and have been evaluated in a narrative format with details on those which are externally validated and their respective citation count on google scholar. RESULTS A total of 54 endourological tools have been described in our atlas of endourological scoring systems, grading tools and nomograms. Of the tools, 23 (43%) are published in the last 3 years showing an increasing interest in this area. This includes 5 for percutaneous nephrolithotomy (PCNL), 6 for flexible ureteroscopy (fURS), 3 for semi-rigid URS (sURS), 9 for shockwave lithotripsy (SWL), 2 for stent encrustations, 3 for intra-operative appearance at the time of URS and 3 to classify intra-operative ureteric injury. There were 3 tools for renal colic assessment, one each for prediction of future stone event, stone classification and stone impaction and 2 for need of emergency intervention in ureteric stone. While 2 tools are related to stone recurrence, 6 are related to post-procedural complications. There are now 2 tools for simulation in endourology and 5 for patient reported outcome measures (PROMS). CONCLUSIONS A number of reliable and established tools exist currently in endourology. Each of these offers their own respective advantages and disadvantages. While nomograms and scoring systems can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations and informed consent.
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Affiliation(s)
- Patrick Jones
- Haukeland University Hospital, 60498, Urology, Bergen, Norway;
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland;
| | - Ben H Chew
- University of British Columbia, Urologic Sciences, Vancouver, British Columbia, Canada;
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland.,University of Southampton, 7423, Southampton, Hampshire, United Kingdom of Great Britain and Northern Ireland;
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