Ashwin Narasimha Sridhar

St Peter's Institute of Urology · Urology

Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. The virtual classroom is comprised of a studio with multiple audio–visual inputs to which parti...

Organ‐sparing radical cystectomy offers selected patients with bladder cancer the opportunity to maintain sexual and urinary function without compromising oncological outcomes.

Introduction Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. Method 72 participants recruited f...

Aim Robotic surgical training has historically lacked evidence-based standardisation. The Fundamentals of Robotic Surgery (FRS) curriculum addresses this by incorporating proficiency-based modules which certify trainees’ skills. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtua...

Background: Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is surging worldwide. Aim of the study was to perform a multicentric cost-analysis of RARC by comparing the gross cost of the intervention across hospitals in four different European countries. Methods: Patients who underwent RARC + ICUD were recruit...

Aims Robotic surgery is an evolving surgical technique, requiring specialist training. The standardised Fundamentals of Robotic Surgery (FRS) curriculum incorporates proficiency-based modules to certify the skills of novice trainees. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive v...

Importance: Robot-assisted radical cystectomy is being performed with increasing frequency, but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer. Objectives: To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs...

Background The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure. Objective To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall...

INTRODUCTION AND OBJECTIVE: Robotic surgery is an established yet evolving surgical technique that requires specialist training. To date, training has lacked evidence-based standardisation. To address this, the Fundamentals of Robotic Surgery (FRS) curriculum has been established, to incorporate proficiency-based modules to certify the skills of no...

Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study al...

Robot-assisted radical prostatectomy (RARP) is the conventional surgical treatment option for localised prostate cancer. We investigated factors which may be associated with recovery of early urinary continence (EUC), including the use of the Retzius-sparing technique (RS-RARP). From March 2018 to December 2018, 501 consecutive patients underwent R...

The accuracy of multi-parametric MRI (mpMRI) in pre-operative staging of prostate cancer (PCa) remains controversial. Objective: To evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan...

Objectives: To test feasibility of randomisation to radical prostatectomy plus pelvic lymphadenectomy (RP) in addition to standard-of-care (SOC) systemic therapy in men with newly diagnosed oligo-metastatic prostate cancer. Patients and methods: A prospective, randomised, non-blinded, feasibility clinical trial with an embedded QuinteT Recruitme...

Aims: Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different...

Background: Radical cystectomy (RC) is associated with high morbidity. Objective: To evaluate healthcare and surgical factors associated with high-quality RC surgery. Design setting and participants: Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study. Ou...

OBJECTIVE This study evaluated the efficacy of virtual classroom training (VCT) in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. DESIGN This was a parallel-group, non-inferiority, prospective randomised controlled trial with three intervention groups conducted in 202...

Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and function...

Objectives Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to im...

Introduction Robotic surgery is an evolving field that requires specialist training. Historically, robotic surgery training has lacked standardisation. Recently, training centres have introduced proficiency-based modules and curriculums to certify and progress the skills of novice robotic surgeons. However, training tends to be self-directed and no...

Introduction High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational ben...

Introduction Robot-assisted surgery is becoming increasingly adopted by multiple surgical specialties. There is evidence of inherent risks of utilising new technologies that are unfamiliar early in the learning curve. The development of standardised and validated training programmes is crucial to deliver safe introduction. In this review, we aim t...

Introduction High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational ben...

Introduction Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT. Method The cases of...

Background: To report the health-related quality of life (HRQoL) after robotic assisted radical cystectomy and intracorporeal urinary diversion (iRARC) and to identify factors impacting on return to baseline. Patients and methods: Consecutive patients undergoing iRARC between January 2016 - December 2017 completed the EORTC-QLQ-C30 and EORTC-QLQ...

Radical prostatectomy (RP) is a standard treatment for men with localised prostate cancer. Robot Assisted Radical Prostatectomy (RARP) is associated with fewer intraoperative adverse events, reduced blood loss and lower complication rates compared to open and laparoscopic surgery but delivers comparable oncological and functional outcomes (1). Furt...

Context: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them. Objectives: To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in...

Introduction Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between similar-risk, propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, on...

Introduction Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. Methods 72 participants recruited f...

Introduction High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction and feedback. They may optimise resources and increase accessibility, facilitating larger-scale training whilst producing...

Background Salvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). Objective The primary objective is to co...

UNSTRUCTURED Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Non-interactive computer-based learning (CBL) is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimise resource...

Background: Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and i...

PurposeTo develop a novel Taiwanese prostate cancer (PCa) risk model for predicting PCa, comparing its predictive performance with that of two well-established PCa risk calculator apps.Methods1545 men undergoing prostate biopsies in a Taiwanese tertiary medical center between 2012 and 2019 were identified retrospectively. A five-fold cross-validate...

Background: To reach a consensus in the classification and standardized reporting for the different types of PCNLs. Methods: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome...

Context The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. Objective To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standar...

Introduction&Objectives: Patients undergoing RARP commonly require 2 group and screen samples pre-operatively. This practice dates from the period when open prostatectomy was the norm. Overall transfusion rate in 2018 from 9747 cases was 0.15%; open 0.78%, laparoscopic 0.49% and robotic 0.08%.Furthermore, day 1 post-operative blood tests are routin...

Objectives To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and Methods We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890...

PIM and PI3K/mTOR pathways are often dysregulated in prostate cancer, and may lead to decreased survival, increased metastasis and invasion. The pathways are heavily interconnected and act on a variety of common effectors that can lead to the development of resistance to drug inhibitors. Most current treatments exhibit issues with toxicity and resi...

The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-...

Objective Technical skills in robot-assisted radical prostatectomy (RARP) are not mandated by the Intercollegiate Surgical Curriculum Programme. The European Association of Urology Robotic Urology Section (ERUS) developed a structured curriculum; however, surgeons’ outcomes data from subsequent independent practice are limited. We describe the init...

Background: Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and onco...

Context The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. Objective To summarize guid...

The ERG oncogene, a member of the ETS family of transcription factor encoding genes, is a genetic driver of prostate cancer. It is activated through a fusion with the androgen-responsive TMPRSS2 promoter in 50% of cases. There is therefore significant interest in developing novel therapeutic agents that target ERG. We have taken an antisense approa...

As the use of robotic surgery for complex procedures increases, there is a growing awareness of the need for validated and standardized curricula that can safely deliver procedural training while limiting errors associated with inexperience. In the article in this issue of JAMA Surgery by Rice et al,¹ the authors have reported the learning curves f...

Context Retzius sparing robotic assisted radical prostatectomy appears to have better continence rates when compared to conventional robotic assisted radical prostatectomy, however, concern with high positive surgical margin rates exist. Objective To systematically evaluate evidence comparing functional and oncological outcomes of retzius sparing...

Background Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes. Objective To report perioperative, functional and oncologic outcomes of sRARP in pat...

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and enable a greater range of downstream applications, a more targeted method of sampling prostate tissue was developed. Here we use both magnetic resonance imaging (MRI) and biopsy data to target sp...

Background: Active surveillance is recommended for insignificant prostate cancer (PCa). Tools exist to identify suitable candidates using clinical variables. We aimed to develop and validate a novel risk score (NRS) predicting which patients are harbouring insignificant PCa. / Methods: We used prospectively collected data from 8040 consecutive unsc...

Background Over one million men are diagnosed with prostate cancer each year worldwide, with a wide range of research programs requiring access to patient tissue samples for development of improved diagnoses and treatments. Random sampling of prostate tissue is sufficient for certain research studies, however there is a growing research need to tar...

The VERDICT framework for modelling diffusion MRI data aims to relate parameters from a biophysical model to histological features used for tumour grading in prostate cancer. Validation of the VERDICT model is necessary for clinical use. This study compared VERDICT parameters obtained ex vivo with histology in five specimens from radical prostatect...

Purpose: We describe the pathological characteristics of recurrence following high intensity frequency ultrasound partial ablation in men treated with salvage robot-assisted radical prostatectomy. We assessed the sensitivity of magnetic resonance imaging before salvage robot-assisted radical prostatectomy in these men. Materials and methods: A t...

Active surveillance is recommended for insignificant prostate cancer (PCa). Tools exist to identify suitable candidates using clinical variables. We aimed to develop and validate a novel risk score (NRS) predicting which patients are harbouring insignificant PCa. We used prospectively collected data from 8040 consecutive unscreened patients who und...

Locating vessels during surgery is critical for avoiding inadvertent damage, yet vasculature can be difficult to identify. Video motion magnification can potentially highlight vessels by exaggerating subtle motion embedded within the video to become perceivable to the surgeon. In this paper, we explore a physiological model of artery distension to...

Locating vessels during surgery is critical for avoiding inadvertent damage, yet vasculature can be difficult to identify. Video motion magnification can potentially highlight vessels by exaggerating subtle motion embedded within the video to become perceivable to the surgeon. In this paper, we explore a physiological model of artery distension to...