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ABSTRACT: Studies involving the formal assessment of surgical skills have often reported inferior abilities among left-handed surgical trainees (LHT). Most surgical training curricula and assessment methods, however, are inherently geared toward right-handed trainees (RHT); potentially placing LHT at both a training and assessment disadvantage. We evaluated the effect of a hand dominance-based curriculum for acquisition of basic suturing and knot tying skills among medical students.
After Institutional Review Board approval, first- and second-year medical students from the University of California, Irvine School of Medicine were recruited to participate in a basic suturing and knot tying skills course. Consenting students were randomized to either a left-handed curriculum or a right-handed curriculum consisting of (1) a 30-minute introductory video and (2) a 2-hour instructor-led, hands-on training session on basic suturing and knot tying. All instructional methods, instruments, and instructors were exclusively right-handed or left-handed for the right-handed curriculum or left-handed curriculum, respectively. Students were assessed on the performance of 2 suturing tasks, continuous running suturing and instrument knot tying, and performance assessments were conducted both immediately and 2 weeks posttraining.
A total of 19 students completed the training course and both assessments (8 LHT, 11 RHT). Students randomized to a curriculum "concordant" with their hand dominance performed significantly better than those randomized to a "discordant" curriculum on both tasks (p < 0.01). This difference was found at both immediate and 2 weeks posttraining assessments. Within concordant and discordant groups, there were no significant differences between LHT and RHT.
This preliminary study demonstrates that medical students, both LHT and RHT, immersed in a training environment that is discordant with their hand dominance might have inferior acquisition of basic suturing and knot tying skills.
03/2013; 70(2):237-42. · 1.07 Impact Factor
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ABSTRACT: Purpose: Recent advances in distal sensor technologies have made distal sensor ureteroscopes both commercially and technically feasible. We evaluated performance characteristics and optics of a new generation distal sensor Flex-XC (Xc) and a standard flexible fiberoptic ureteroscope Flex-X2 (X2), both Karl Storz, Tuttlingen, Germany. Material and Methods: The ureteroscopes were compared for active deflection, irrigation flow and optical characteristics. Each ureteroscope was evaluated with an empty working channel and with various accessories. Optical characteristics (resolution, grayscale imaging and color representation) were measured using USAF test targets. We digitally recorded a renal porcine ureteroscopy and laser ablation of a stone with the X2 and with the XC. Edited footage of the recorded procedure was shown to different expert surgeons (n=8) on a HD monitor for evaluation by questionnaire for image quality and performance. Results: The XC had a higher resolution than the X2 at 20 and 10mm 3.17 lines/mm vs. 1.41 lines/mm, 10.1 vs. 3.56, respectively (p=0.003,p=0.002). Color representation was better in the XC. There was no difference in contrast quality between the two ureteroscopes. For each individual ureteroscope, the upward deflection was greater than the downward deflection both with and without accessories. When compared to the X2, the XC manifested superior deflection and flow (p<0.0005,p<0.05) with and without accessory present in the working channel. Observers deemed the distal sensor ureteroscope superior in visualization in clear and bloody fields, as well as for illumination.(p=0.0005, p=0.002, p=0.0125) Conclusions: In this in vitro and porcine evaluation the distal sensor ureteroscope provided significantly improved resolution, color representation and visualization in the upper urinary tract compared to a standard fiberoptic ureteroscope. The overall deflection was also better in the XC and deflection as well as flow rate was less impaired by the various accessories.
Journal of endourology / Endourological Society 02/2013; · 1.75 Impact Factor
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ABSTRACT: Ureteroscope breakage is commonly related to laser fiber damage. Often, the damage is mechanical and not energy related. As such, we evaluated a novel laser fiber and sheath system in preventing mechanical ureteroscope damage during fiber insertion. We assessed 200μm/272/3μm laser fibers with the laser sheath in a flexible ureteroscope. Diminishment of active deflection and irrigation flow rates were compared to a standard Laser fiber alone. Eight non-assembled working channel components were tested in a 0°/90°/210° deflection model. After insertion cycles external and endoluminal damage to the working channel were classified. We also tested the sheath system in a 0°/90°/210° deflection model for fiber failure and laser damage. In all test trials with the sheath, and for standard laser fibers in the 0° model, there were no channel perforations or damage. With standard laser fibers, in the 210° model superficial scratches and demarcated abrasions were visible after 10 and 60-70 insertions for the 273μm laser fiber and after 30 insertions (superficial scratches) for the 200μm laser fiber. In the 90° model, superficial scratches occurred after 20 insertions for the 273μm fibers and after 40 insertions for the 200μm laser fibers. No demarcated abrasions were seen after 100 insertions. In the 210° model there was 1 perforation with the 272μm fiber, but none with 200μm fiber. There were no fiber failures with sheath use; however, the sheath did not prevent laser energy damage. The laser sheath resulted in a 4.7°/3.8° (1.2%/1.5%) diminishment in deflection (up/down) for the 200μm and a 3.5°/4.3° (1.8%/1.5%) diminishment for 272μm laser fiber compared to standard 200/272μm laser fiber. Irrigation flow was diminished with the sheath on both the 200μm and 272μm laser fiber by 28.7% and 32.6%, respectively. The Scope Guardian Sheath prevented mechanical working channel damage with minimal diminishment of deflection and irrigation flow.
Journal of endourology / Endourological Society 01/2013; · 1.75 Impact Factor
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Ashleigh D Menhadji,
Corollos Abdelshehid,
Kathryn E Osann,
Reza Alipanah,
Achim Lusch,
Joseph A Graversen,
Jason Y Lee,
Stephen Quach,
Victor B Huynh,
Daniel Sidhom,
Isabelle Gerbatsch,
Jaime Landman, Elspeth M McDougall
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ABSTRACT: OBJECTIVE: Tracking the progression of technical skill acquisition during urology residency training is an essential yet challenging task that has been mostly based on anecdotal and subjective performance assessment. We evaluated 5 surgical tasks utilized at our institution to assess skill acquisition among residents over 4 consecutive years in an effort to determine appropriate skill testing for resident proficiency relative to level of training for future performance testing. METHODS: Urology residents were tested yearly throughout the course of their residency with 5 surgical tasks in an open, laparoscopic, and robotic format. The 5 tasks were: 1) rings on a peg, 2) thread the rings, 3) cut the line, 4) hexagonal suturing and 5) suture and knot tying. Evaluation was performed by a trained instructor to assess quantity and quality of the skill task performance. RESULTS: The highest scores were obtained on all open tasks regardless of training level. Residents performed second best on robotic and lowest on the laparoscopic skill tasks. The score difference among surgery platforms was statistically significant p<0.0005 across all tasks. However, it was tasks 2 and 5 which showed a statistically significant difference in overall quantity x quality score between different PGY residents (p=0.03 and p=0.02). In addition, the quantity score for task 5 also showed a statistically significant difference among PGY residents (p=0.04). There was no statistically significant difference in time to perform tasks among PG years. CONCLUSIONS: The high-level tasks 2 and 5 were the most useful in differentiating different levels of skill task competency among urology residents and appear to be most useful in assessing the degree of improvement among residents during training. These tasks have subsequently been worked into our institution's testing curriculum.
Journal of endourology / Endourological Society 12/2012; · 1.75 Impact Factor
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ABSTRACT: Abstract Purpose: Virtual reality simulators with self-assessment software may assist novice robotic surgeons to augment direct proctoring in robotic surgical skill acquisition. We compare and correlate the da Vinci Trainer™ (dVT) and da Vinci Surgical Skills Simulators (dVSSS) in subjects with varying robotic experience. Materials and Methods: Students, urology residents, fellows, and practicing urologists with varying robotic experience were enrolled after local institutional review board approval. Three virtual reality tasks were preformed in sequential order (pegboard 1, pegboard 2, and tubes)-initially on the dVSSS and then on the dVT. The Mimic™ software used on both systems provides raw values and percent scores that were used in statistical evaluation. Statistical analysis was performed with the two-tailed independent t-test, analysis of variance, Tukey, and the Pearson rank correlation coefficient where appropriate. Results: Thirty-two participants were recruited for this study and separated into five groups based on robotic surgery experience. In regards to construct validity, both simulators were able to differentiate differences among the five robotic surgery experience groups in the tubes suturing task (p≤0.00). Sixty-seven percent (4/6) robotic experts thought that surgical simulation should be implemented in residency training. The overall cohort considered both platforms easy to learn and use. Conclusions: Although performance scores were less in the dVT compared with the dVSSS, both simulators demonstrate good content and construct validity. The simulators appear to be equivalent for assessing surgeon proficiency and either can be used for robotic skills training with self-assessment feedback.
Journal of endourology / Endourological Society 07/2012; · 1.75 Impact Factor
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Adam G Kaplan,
Corollos S Abdelshehid,
Narges Alipanah,
Tahereh Zamansani,
Jason Lee,
Surendra B Kolla,
Petros G Sountoulides,
Joseph Graversen,
Achim Lusch,
Oskar G Kaufmann,
Michael Louie,
Ralph V Clayman, Elspeth M McDougall
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ABSTRACT: Abstract Purpose: We developed a genitourinary skills training (GUST) curriculum for incoming third year medical students (MS3) and performed a follow-up study of comfort with and utilization of these skills. Materials and Methods: GUST consisted of a didactic lecture followed by skills sessions including standardized patient testicular examination (TE) and digital rectal examination (DRE), male and female Foley catheter (MFC and FFC) placement training, suture-knot tying, and a faculty-directed small group learning session. Precourse and postcourse, and 6 and 18 months after the course, MS3 rated comfort with each skill (Likert scale 0-5), and quantified skill usage. Results were compared with 4th year students (MS4) who had not undergone GUST. Results: Participants were 281 MS3 GUST students and 44 MS4. Post-GUST, mean comfort on a Likert scale (0=uncomfortable) increased for all four skills (88.2%-96.9% vs 8.3%-18.5%, P<0.0001). This was maintained at the 6-month and 18-month follow up time points (P<0.0001). At 18 months, MS3 trended toward higher comfort with TE compared with MS4 (74 vs 54%, P=0.068), while with the other skills, both groups showed equal comfort. MS4 learned exam skills from faculty and MFC and FFC from nurses on the wards. Eleven percent of MS4 were never formally taught TE or DRE. MS3 and MS4 performed TE and/or DRE on <8% of newly admitted patients. Conclusions: MS3 described improved comfort with the GU skills at all time points during follow-up. This was particularly important because both MS3 and MS4 reported using their skills infrequently during their clinical training years.
Journal of endourology / Endourological Society 06/2012; 26(10):1350-5. · 1.75 Impact Factor
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Adam C Mues,
Ruslan Korets,
Joseph A Graversen,
Ketan K Badani,
Vincent G Bird,
Sara L Best,
Jeffrey A Cadeddu,
Ralph V Clayman, Elspeth McDougall,
Kurdo Barwari, [......],
Ravi Munver,
Sutchin R Patel,
Stephen Nakada,
Matvey Tsivian,
Thomas J Polascik,
Arieh Shalhav,
W Bruce Shingleton,
Emilie K Johnson,
J Stuart Wolf,
Jaime Landman
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ABSTRACT: Abstract Background and Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. Patients and Methods: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. Results: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. Conclusions: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.
Journal of endourology / Endourological Society 06/2012; 26(10):1361-6. · 1.75 Impact Factor
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ABSTRACT: Medical students pursue different career paths based on a variety of factors. We sought to examine the impact of innate manual dexterity, both perceived and objective, on the career interests of medical students.
Third-year medical students from the University of California, Irvine were recruited for this study. Subjects completed a pretest questionnaire followed by assessment of gross and fine motor dexterity using the Purdue Pegboard test. A total of 6 independent trials were performed, 3 for each hand. The scores were recorded as an integer value between 0 and 25. A statistical analysis was performed using student t tests, the Fischer exact test, or the χ(2) test, where appropriate.
A total of 100 students completed the questionnaire while 58 completed the dexterity testing. Students interested in a surgical field (SF) were similar in handedness, gender, video game exposure, and learning style as those interested in a nonsurgical field (NSF). In the SF group, "personal skill set" was reported as the most common factor influencing career selection, and "interest in disease process/patient population" was reported most commonly by NSF students (p = 0.015). Although a perceived innate manual dexterity was higher among SF students compared with NSF students (p = 0.032), no significant objective differences were found in right hand, left hand, or combined dexterity scores.
Perceived "personal skill set" may influence strongly a medical student's career choice. Despite greater perceived manual dexterity, students interested in an SF do not have greater objective innate manual dexterity than those interested in an NSF.
05/2012; 69(3):360-3. · 1.07 Impact Factor
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Phillip Mucksavage,
Donald Pick,
Dana Haydel,
Mohammed Etafy,
David C Kerbl,
Jason Y Lee,
Cervando Ortiz-Vanderdys,
Fatma Saleh,
Stephania Olamendi,
Michael K Louie, Elspeth M McDougall
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ABSTRACT: The flow characteristics, ureteral conformance, and histopathologic changes of a novel spiral cut flexible ureteral stent (Percuflex Helical, Boston Scientific, Boston, MA) were evaluated in vivo in an acute and chronic porcine model.
Flow characteristics and ureteral conformance of the novel stent were determined in 6 acute and 6 chronic swine models and compared with a control ureteral stent (Percuflex Plus, Boston Scientific). The flow characteristics were determined in vivo after ligating the renal vessels and via a nephrostomy tube delivering a standard rate of 0.9% saline at 35 cm H(2)O. Flows in the unobstructed ureter, normal stent, intraluminally obstructed stent, extraluminal obstructed stent, and both intraluminally and extraluminally obstructed conditions were determined. In the chronic animals, flow was determined at day 10, with the stent in place and immediately after stent removal. Conformance and hydronephrosis was assessed on pyelograms. Histopathologic changes were also evaluated in the chronic animals.
The acute and chronic flow characteristics in the novel stent were equivalent to the control stent. Size and weight of the kidney, degree of hydronephrosis, stent migration, and presence of urinary tract infection were also similar between the test and control stents. There were no differences seen in histopathologic grading or degree of encrustation in either stent. The novel stent appeared to conform better to the shape of the ureter in both acute and chronic animals.
The novel helical stent appears to drain as well as a standard stent and causes no increased degree of histopathologic changes in the ureter.
Urology 03/2012; 79(3):733-7. · 2.43 Impact Factor
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ABSTRACT: Virtual reality simulators are often used for surgical skill training since they facilitate deliberate practice in a controlled, low stakes environment. However, to be considered for assessment purposes rigorous construct and criterion validity must be demonstrated. We performed face, content, construct and concurrent validity testing of the dV-Trainer™ robotic surgical simulator.
Urology residents, fellows and attending surgeons were enrolled in this institutional review board approved study. After a brief introduction to the dV-Trainer each subject completed 3 repetitions each of 4 virtual reality tasks on it, including pegboard ring transfer, matchboard object transfer, needle threading of rings, and the ring and rail task. One week later subjects completed 4 similar tasks using the da Vinci® robot. Subjects were assessed on total task time and total errors using the built-in scoring algorithm and manual scoring for the dV-Trainer and the da Vinci robot, respectively.
Seven experienced and 13 novice robotic surgeons were included in the study. Experienced surgeons were defined by greater than 50 hours of clinical robotic console time. Of novice robotic surgeons 77% ranked the dV-Trainer as a realistic training platform and 71% of experienced robotic surgeons ranked it as useful for resident training. Experienced robotic surgeons outperformed novices in many dV-Trainer and da Vinci robot exercises, particularly in the number of errors. On pooled data analysis dV-Trainer total task time and total errors correlated with da Vinci robot total task time and total errors (p = 0.026 and 0.011, respectively).
This study confirms the face, content, construct and concurrent validity of the dV-Trainer, which may have a potential role as an assessment tool.
The Journal of urology 03/2012; 187(3):998-1002. · 4.02 Impact Factor
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ABSTRACT: Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents.
Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales.
A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments.
Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance.
The Journal of urology 02/2012; 187(4):1385-91. · 4.02 Impact Factor
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ABSTRACT: Surgery is a high-stakes "performance." Yet, unlike athletes or musicians, surgeons do not engage in routine "warm-up" exercises before "performing" in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery.
Serving as their own controls, each subject performed two pairs of laparoscopic cases, each pair consisting of one case with POWER (+POWER) and one without (-POWER). Subjects were randomly assigned to +POWER or -POWER for the initial case of each pairing, and all cases were performed ≥ 1 week apart. POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer. For each case, cognitive, psychomotor, and technical performance data were collected during two different tasks: mobilization of the colon (MC) and intracorporeal suturing and knot tying (iSKT). Statistical analysis was performed using SYSTAT v11.0.
A total of 28 study cases (14+POWER, 14-POWER) were performed by seven different subjects. Cognitive and psychomotor performance (attention, distraction, workload, spatial reasoning, movement smoothness, posture stability) were found to be significantly better in the +POWER group (P ≤ 0.05) and technical performance, as scored by two blinded laparoscopic experts, was found to be better in the +POWER group for MC (P=0.04) but not iSKT (P=0.92). Technical scores demonstrated excellent reliability using our assessment tool (Cronbach ∝=0.88). Subject performance during POWER was also found to correlate with intraoperative performance scores.
Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance.
Journal of endourology / Endourological Society 12/2011; 26(5):545-50. · 1.75 Impact Factor
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ABSTRACT: Many surgical training programs utilize simulation-based strategies for instruction and assessment of laparoscopic skills. While the use of inanimate, animate, and virtual-reality simulation for basic or procedural skills training has been well described, the use of simulation for the purpose of training surgeons in managing intraoperative laparoscopic complications has been given less attention. We describe a novel, affordable inanimate surgical model for use in simulation-based training of laparoscopic renal hilar vessel injury management.
Using a laparoscopic box trainer, a half-inch Penrose drain, standard silicone intravenous tubing, and a commercially available kidney part-task trainer, an inanimate surgical training model was developed to simulate various clinical scenarios involving renal hilar vessel injuries. To evaluate the construct validity of this training model, urology residents from the University of California, Irvine, completed a simulated scenario involving a renal vein injury (RVI) during laparoscopic radical nephrectomy (LRN).
This surgical model is able to simulate both renal arterial and venous injuries during laparoscopic radical and partial nephrectomy scenarios. Initial cost to construct the model was ~800 U.S. dollars (USD) and each subsequent use was an additional 7 USD. Resident training level correlated strongly with technical performance (p<0.01) and "blood loss" (p=0.02) during the "RVI during LRN" scenario. The checklist and global rating scale used to assess performance demonstrated adequate reliability (Cronbach's α=0.82).
While further validation, technical refinement, and improved fidelity are being considered, we present a novel, affordable surgical model for simulating laparoscopic renal hilar vessel injuries that is suitable for urology trainees.
Journal of endourology / Endourological Society 12/2011; 26(4):393-7. · 1.75 Impact Factor
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Jennifer L Young,
David W McCormick,
Surrendra B Kolla,
Petros G Sountoulides,
Oskar G Kaufmann,
Cervando G Ortiz-Vanderdys,
Victor B Huynh,
Adam G Kaplan,
Nick S Jain,
Donald L Pick,
Lorena A Andrade,
Kathryn E Osann, Elspeth M McDougall,
Ralph V Clayman
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ABSTRACT: To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy.
Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes. These 12 cryolesions were compared with 12 cryolesions using a single IceRod cryoprobe. Each cycle consisted of two 10-minute freeze cycles separated by a 5-minute thaw. The iceball volume was measured using intraoperative ultrasonography. The kidneys were harvested, and cryolesion surface area was calculated. The lesions were fixed and excised to obtain a volume measurement. Statistical analysis was used to compare the single probe results multiplied by 3 to the multiple probe group for iceball volume, cryolesion surface area, and cryolesion volume.
The iceball volume for the first freeze cycle for the single cryoprobe multiplied by 3 was 8.55 cm3 compared with 9.79 cm3 for the multiple cryoprobe group (P=.44) and 10.01 cm3 versus 16.58 cm3 for the second freeze (P=.03). The cryolesion volume for the single cryoprobe multiplied by 3 was 11.29 cm3 versus 14.75 cm3 for the multiple cyroprobe group (P=.06). The gross cryolesion surface area for the single cryoprobe multiplied by 3 was 13.14 cm2 versus 13.89 cm2 for the multiple probe group (P=.52).
The cryolesion created by 3 simultaneously activated 1.47-mm probes appears to be larger than that of an additive effect. The lesions were significantly larger as measured by ultrasonography and nearly so (P=.06) as measured by the gross cryolesion volume.
Urology 12/2011; 79(2):484.e1-6. · 2.43 Impact Factor
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ABSTRACT: The Fundamentals of Laparoscopic Surgery (FLS(™)) skills curriculum has validity evidence supporting use for assessing laparoscopic skills for general surgeons. As charged by the American Urological Association (AUA) Laparoscopy, Robotic, and New Surgical Technology Committee, we sought to develop and validate a urology-specific FLS, referred to as the Basic Laparoscopic Urologic Surgery (BLUS(©)) skills curriculum. The psychomotor component consists of three existing FLS tasks and one new clip-applying task.
An animate renal artery model was designed for a clip-applying skills task. We assessed the acceptability and construct validity of using BLUS for basic laparoscopic skills assessment for urologists. A cohort of practicing urologists, fellows, residents, and medical students completed the tasks at the AUA Annual Meetings in 2010 and 2011.
All exercises were acceptable and demonstrated excellent face and content validity (>4.5/5 on a five-point Likert scale). Practicing clinical urologists (N=81) outperformed residents and medical students (N=35) in time to completion of circle cut (P<0.01) and in keeping scissor tips toward the center of the circle (P<0.01). Practicing urologists who reported >3 laparoscopic procedures per week were faster at the peg-transfer exercise (P<0.05) and the cutting exercise (P<0.01) than those reporting one to two procedures. More errors were committed for clip-applying among practicing urologists who perform one to two laparoscopic procedures (1.24) vs. those who perform >3 procedures (0.57) per week (P<0.01).
All exercises including the novel clip-applying model demonstrated good acceptability and evidence of construct validity (face, content, concurrent and convergent validity) for assessment of basic laparoscopic skill for urologic surgeons.
Journal of endourology / Endourological Society 11/2011; 26(2):190-6. · 1.75 Impact Factor
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ABSTRACT: Performing warm-up exercises before athletic competition or stage performance is very common; however, most surgeons do not "warm up" before performing complex surgery. We analyzed the intraoperative effects of warming up before surgery in an experienced laparoscopic surgeon.
A retrospective review of all laparoscopic partial (LPN) and radical nephrectomies (LRN) completed by an experienced laparoscopic surgeon (RVC) were analyzed according to whether warm-up exercises were performed before surgery. Routine warm-up consisted of 15 to 20 minutes of pelvic trainer suturing exercises (forehand and backhand sutures and knot tying), using both hands. Intraoperative and postoperative parameters were examined.
LRN and LPN subjects were well matched among the warm-up group and nonwarm-up group. Patients in the LPN warm-up group did have significantly larger tumors (3.7 cm vs 2.4 cm, P=0.02). Despite larger tumors, surgical time was significantly less in the warm-up group (227 min vs 281 min, P=0 .04), and total operating room time trended toward significance (320 min vs 371 min, P=0.0501). Similarly, in the LRN group, operative times and total operating room time was significantly less in the preoperative warm-up group (P=0.0068 and P=0.014, respectively). Intraoperative and postoperative complications, estimated blood loss, positive margin rate, warm ischemia time, length of stay, changes in hemoglobin and creatinine levels from baseline were not significantly different between the two groups.
Performing warm-up exercises before complex laparoscopic surgery may improve operative times and performance in the operating room, especially for complex laparoscopic surgeries.
Journal of endourology / Endourological Society 11/2011; 26(7):765-8. · 1.75 Impact Factor
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ABSTRACT: To evaluate a materials model for laparoscopic ultrasound identification and partial nephrectomy of kidney tumors.
Five urology fellows performed laparoscopic ultrasonography (LUS) examination of the tumor model, and the time for identification was recorded. After identifying the tumor, they performed a laparoscopic partial nephrectomy using the target tumor with measurement of operative parameters. They completed a questionnaire and rated the quality of the renal tumor model on a 5-point Likert scale.
The participants were able to identify 49 tumors by LUS (98%). The mean time to identify the renal tumors by LUS was 1.12 minutes ± 0.93 standard deviation (SD). A partial nephrectomy was successfully completed on 49 tumor models (98%). The mean resection time was 7.69 minutes ± 3.8 SD. All of the participants considered that this model was helpful in the practice of LPN. The fellows would recommend this model as a teaching tool for residents/fellows to perform tumor imaging by LUS and for practicing LPN in a simulated environment.
We have developed a unique model that simulates small kidney tumors that can be used for training surgeons in the clinical skills of laparoscopic partial nephrectomy.
Journal of endourology / Endourological Society 09/2011; 26(1):1-5. · 1.75 Impact Factor
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ABSTRACT: To determine laparoscopic and robotic surgical practice patterns among current postgraduate urologists.
There were 9,095 electronic surveys sent to practicing urologists with e-mail addresses registered with the American Urological Association.
Responses were received from 864 (9.5%) urologists; 84% report that laparoscopic or robotic procedures are performed in their practice. The highest training obtained by the primary laparoscopist was fellowship (31%), residency (23%), or 2- to 3-day courses (22%). Eighty-six percent report performance of laparoscopic nephrectomy in their practice, and 71% consider it the standard of care. Sixty-six percent of practices have access to at least one robotic unit, and 9% plan on purchasing one within a year. Attitudes toward robotics are favorable, with 80% indicating that it will increase in volume and potential procedures. Thirty-one percent state that robot-assisted prostatectomy is standard of care, while 50% believe this procedure looks promising. Respondents think that optimal training in minimally invasive techniques is fellowships (23%), minifellowships (23%), or hands-on courses (23%). Twenty-nine percent think that they were trained adequately in laparoscopy and robotics from residency, and 62% believe residents should be able to perform most laparoscopic procedures on completion of residency.
The practice and availability of laparoscopic and robotic procedures have increased since previous evaluations. Opinions regarding these techniques are favorable and optimistic. As the field of urology continues to see a growing demand for minimally invasive procedures, training of postgraduate urologists and residents remains essential.
Journal of endourology / Endourological Society 08/2011; 25(11):1797-804. · 1.75 Impact Factor
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ABSTRACT: To evaluate a materials model for laparoscopic guided cryotherapy or radiofrequency tissue ablation (RFA) of kidney tumors through expert surgeon assessment.
During the inaugural American Urological Association 2010 Tissue Ablative course content, validity testing of a renal tumor model was undertaken. Five expert faculty in cryotherapy and RFA techniques for renal tumors performed laparoscopic ultrasonography (US) examination of the tumor model. They performed US guided placement and activation of the treatment probe into the tumor of the model. They completed a questionnaire and rated the quality of the renal tumor model on a 5 point Likert scale.
All of the subjects assigned a score of 5 of 5 on the Likert scale regarding the ability to identify the tumor with US, were able to deploy the ablative probe into the model under US guidance, and would recommend the use of this teaching model to residents or fellows. They thought that this tumor model was appropriate for teaching laparoscopic US imaging of a renal tumor during ablative treatment procedures, teaching and practicing laparoscopic US-guided cryotherapy, and teaching and practicing laparoscopic US-guided RFA.
We have developed a unique model that simulates small kidney tumors that can be used for training surgeons in ablative techniques.
Journal of endourology / Endourological Society 08/2011; 25(8):1371-5. · 1.75 Impact Factor
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ABSTRACT: June 25, 2010 marks the twentieth anniversary of the first clinical laparoscopic nephrectomy. Since the advent of this procedure a paradigm shift toward minimally invasive options for urological surgery has been witnessed, resulting in rapid technological innovations and improved patient outcomes. A history of the minimally invasive surgical management of renal masses is presented with a focus on laparoscopic nephrectomy.
The Journal of urology 03/2011; 185(3):1150-4. · 4.02 Impact Factor
