We evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to assess our structured teaching program.
We retrieved 383 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) from our database. Trainees completed a structured teaching program and were categorized as early (days 0 to 232), mid (days 566 to 797), and late (days 825 to 1218) according to the time period in which they were working with the mentor. We compared operative times, estimated blood loss (EBL), and positive surgical margin (PSM) rates between the trainees and the mentor (Mann-Whitney and Chi-square test). Association of EBL, body mass index (BMI), and prostate weight with operative time was evaluated in multivariate linear regression analysis.
Median operative times of the early, mid, and late trainees (258, 220, and 200 minutes) significantly decreased and were similar to the corresponding senior surgeon's (254, 242, and 180 minutes). Operative times decreased with lower BMI, EBL, and prostate weight (P = 0.006, P <0.001, and P <0.001, respectively). Overall, EBL (150 mL vs. 150 mL, P = 0.215) and PSM rates (20% vs. 18.6%, P = 0.741) did not differ between the mentor and the trainees.
A structured teaching program for RALP is effective and trainees are able to adopt the increased efficiency and skills of their mentor. Lower BMI, EBL, and prostate weight were associated with shorter operative times. Trainees performing the procedure did not negatively affect EBL and positive surgical margin rate.
"They concluded that previous purported concerns with respect to oncological outcomes as a result of lack of tactile feedback were unfounded. Schroeck et al.  evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to gain some insight into the question of whether trainees negatively impact on the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate. They concluded that a structured teaching program for RALP is effective and that trainees did not negatively affect the estimated blood loss and positive surgical margin rate. "
[Show abstract][Hide abstract] ABSTRACT: Our goal was to evaluate posterior reconstruction of the rhabdosphincter during robot-assisted radical prostatectomy and determine whether this technique decreased anastomotic time of a surgeon in training to perform vesicourethral reconstruction.
We reviewed the first 25 robot-assisted prostatectomies performed by 2 urology surgeons in training (surgeon 1 and surgeon 2). The patient populations were matched for age, Gleason score, clinical stage, and PSA. Whereas surgeon 1 performed the vesicourethral anastomosis without posterior reconstruction, surgeon 2 reapproximated Denonvilliers' fascia of the posterior bladder to the rhabdosphincter. Time for each surgeon to complete the anastomosis and clinical factors was compared.
Surgeon 1 had a median anastomosis time of 25 minutes (range, 17 to 48), whereas surgeon 2 had a median anastomosis time of 15 minutes (range, 10 to 30) (P<0.001). Biopsy Gleason score, pathological tumor stage, perineural invasion, median age at the time of surgery, PSA, prostate weight, and estimated blood loss were not significantly different between surgeons (P>0.05). Pathological Gleason score (P=0.045) and total console time (surgeon 1-216 minutes, surgeon 2-176 minutes; P=0.002) were significantly different between surgeons.
Posterior reconstruction prior to anastomosis decreases anastomosis time for robotic surgeons in training.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 10/2010; 14(4):520-4. DOI:10.4293/108680810X12924466008204 · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The influence of alloying on the ignition and flammability was studied. One end of a cylindrical specimen was exposed to a free diffusion flame. Ignition required at least partial melting. Burning extinguished once the flame was withdrawn. Specimen tips of pure Mg, AZ61, and AZ91 ignited upon prolonged flame exposure. There was smouldering and delayed ignition for Mg-1Y. There was no ignition for Mg-5Y specimen tips, attributed to a protective surface oxide containing Y. The results indicate that (i) vigorous burning requires a continued supply of Mg vapour, and (ii) a critical alloy concentration is required to change ignition behaviour.
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