Chandra Shekhar Biyani

Leeds Teaching Hospitals NHS Trust · Department of Urology

Background and aims Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC. Methods Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions...

Autonomous robotic Ultrasound (US) scanning has been the subject of research for more than 2 decades. However, little work has been done to apply this concept into a minimally invasive setting, in which accurate force sensing is generally not available and robot kinematics are unreliable due to the tendon-driven, compliant robot structure. As a res...

Understand the importance of feedbackIdentify the key requirements for delivering good feedbackExplore the pros and cons of different feedback modelsUnderstand some of the barriers to effective feedback, and relate these to your own practice. Understand the importance of feedback Identify the key requirements for delivering good feedback Explore th...

Aim: Achieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic. Background: A global survey conducted by our team demonstrated significant disruption in surgical training during the COVID...

Background and Aims Poor well-being affects the performance of all kinds of workers, including surgeons. This study aimed to answer two questions: (1) how does burnout affect surgeons personally, and what is their burnout experience like? (2) How does burnout affect the care that surgeons provide in the United Kingdom (UK)? Method This study condu...

Aim Stents are widely used in the management of ureteric strictures but require changes every 6–12 months and stent related symptoms are commonly reported. AlliumTM ureteric stents are large calibre, metallic stents that aim to reduce the incidence of stent-related complications, with an indwelling time up to three years. These were introduced with...

Objectives To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management. Patients and Methods A 2517 patient dataset was utilised from an international multicentre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflamma...

Surgical outcomes are traditionally reported using postoperative metrics. Routine data collection of postoperative complications and histological outcomes are widely used as surrogate markers of surgical quality. Although these measures can provide an overall account of surgical outcomes, they may not reliably reflect surgical skill and or competen...

Background Stone disease is a common complication of horseshoe kidneys (HSK). There are currently limited studies that examine the relationship between HSK anatomy and stone formation. We aim to determine if there is such an association by measuring the isthmus size and renal angulation in both stone and non-stone forming HSK using computed tomogra...

Introduction Nomograms, used to predict the risk and success of treatment of urinary tract stones, are being used in paediatric clinical practice. However, no studies have determined the best prediction model. This study aimed to identify the most robust nomogram(s) for predicting clinically relevant outcomes in urinary stone disease in paediatric...

Percutaneous nephrostomy insertion is a technique performed by an interventional radiologist or a urologist for an acutely or long-standing obstructed urinary tract. Mastering the technique involves overcoming a steep learning curve. Various methods of training have been developed over the years to facilitate learning. These vary from simple physic...

Background Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. Purpose This study aimed...

Background The coronavirus pandemic has had an indisputable impact on surgical training. The qualitative effect on the perceived confidence and capability of trainees has been widely reported. In order to fully delineate the scope of the problem, quantitative data is also required. Methods This cross-sectional study collected compared data on the...

Examination of the scrotum is an essential skill for emergency, surgical and general practice (GP) clinicians. However, the examination poses a number of challenges due to its intimate nature and wide range of potential pathologies, resulting in many UK trainees feeling uncomfortable and underconfident in this skill. This article aims to address th...

Background Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. Objective To develop Intraoperative Complication...

The Royal College of Physicians and Surgeons of Glasgow is a community of health professionals working together to develop and improve patient care. The College is dedicated to supporting its members through education, training and continuing professional development. Furthermore, the College is committed to good global citizenship and has supporte...

Although penoscrotal and catheterization procedures are basic skills, it is very important for students and residents to master these skills in a learner-centered environment. Multiple training models are available for simulation training.KeywordsSimulationTrainingVasectomyVasovasostomyCircumcisionParaphimosisPriapismPeyronie'sPenile fractureCathet...

Acquisition of surgical skills by simulation has become the foundation of modern surgical training. As the training opportunities in modern surgical skills centers are limited due to cost and availability; many low-cost, easily available and sustainable alternatives for simulation of surgical training have been developed. This is a reappraisal of l...

Developing and implementing a simulation program is a complex, multi-phase, and demanding process. The necessity for the implementation science in healthcare simulation is now broadly acknowledged, so educators in leadership positions have a responsibility to minimise “trial-and-error” approach and ensure the implementation of evidence-based simula...

Simulation-based training nowadays constitutes a large part of the procedural learning curve and can be acquired using training models. Procedural training simulators imitate some aspect of human anatomy or surgical step, facilitating a learning activity through simulation of characteristics of that anatomy or step. Applying surgical simulators off...

Simulation for teaching and training in functional urology, especially female urology, is an understudied but growing field. Anatomical training and training on anatomical landmarks for pelvic floor surgery have benefited from several simulation tools such as 3D models, virtual reality and 3D printing. The variable nature of the female pelvic floor...

Intraoperative adverse events (iAEs) are under-reported, have poorly standardized nomenclature, and are plagued by barriers to reporting and cultural acceptance. Not surprisingly, although surgeons are willing to report iAEs, they often under-report these events, especially those of lower severity, owing to perceived clinical insignificance¹. Attem...

Surgical training has undergone a paradigm shift as the acquisition phase of surgical skills has transitioned from the operating theatre to the simulation lab. Several factors have led to this shift; including reduced operative volumes, the need for competence-based curricula and ethical concerns in relation to patient safety. Yorkshire and Humber...

Background Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) sur...

Background The growth of “bootcamp style” simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented...

Background: The Performance Improvement score (Pi-score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. Methods: The Pi...

Background The SARS-Cov-2 pandemic had a profound impact on surgical services, potentially causing a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This w...

Objective To design and assess a novel penile fracture simulation model for teaching penile fracture repair. Methods We used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit (“simulated fracture”) was created on one part of the first half of the foreskin (mimicking “tu...

The introduction of laparoscopic surgery has several advantages including shorter hospital stay, less pain, and smaller scars. This new surgical technique, however, provoked a paradigm shift in training modality. It was a difficult task to acquire these complex surgical skills in demanding and constantly changing operating room settings due to the...

Objectives The objective of our study was to study trainees’ feedback and rating of models for training transurethral resection of bladder lesions (TURBT) and prostate (TURP) during simulation. Methods The study was performed during the ‘‘Transurethral resection (TUR) module” at the boot camp held in 2019. Prior to the course, all trainees were re...

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the p...

The operative and non-technical skills exposure of urology trainees has reduced due to a number of factors, including the European Working Time Directive, and the COVID-19 pandemic. Simulation-based education (SBE) is an innovative addition to clinical experience which can begin to address the skills-based learning deficiency in order to help train...

Objective: To design and assess a novel penile fracture simulation model for teaching penile fracture repair. Methods: We used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit ("simulated fracture") was created on one part of the first half of the foreskin (mimicking...

Objective To develop an assessment instrument that can be used as a comprehensive feedback record to convey to a trainer the non-technical aspects of skill acquisition and training. Methods The instrument was developed across three rounds. In Round 1, 6 endourological consultants undertook a modified Delphi process. Round 2 included 10 trainers wh...

Background The COVID-19 pandemic represents the greatest biopsychosocial emergency the world has faced for a century. The pandemic has changed how individuals live and work, and in particular, frontline healthcare professionals have been exposed to alarming levels of stress. Objective The aim of this study was to understand the professional and pe...

Background: The SARS-CoV-2 pandemic had a profound impact on surgical services, potentially having a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and to develop a framework for recovery. Methods: A cross-sectional, web-based survey was conducted....

Background Ischaemic priapism is a urological emergency. Early treatment is required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teach t...

Background The SARS-CoV-2 pandemic had a profound impact on surgical services, potentially having a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and to develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This...

Background: Ischaemic priapism is a urological emergency with early treatment required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teac...

In surgical robotics, the ability to achieve high levels of autonomy is often limited by the complexity of the surgical scene. Autonomous interaction with soft tissues requires machines able to examine and understand the endoscopic video streams in real-time and identify the features of interest. In this work, we show the first example of spatio-te...

Background Urolithiasis has a significant impact on patients’ health-related quality of life (HRQoL). Objective To develop a core patient-reported outcome measure (PROM) using modern psychometric methods to quantify the impact of urolithiasis and different treatments. Design, setting, and participants Adult patients with urinary calculi, attendin...

Cystinuria is the most common cause of inherited stone disease and is caused by the failure of absorption of filtered dibasic amino acids including cystine in the proximal tubules. It is associated with a very high recurrence rate in affected patients, with the potential for significant morbidity in such patients due to the need for repeated surgic...

The COVID-19 crisis has fundamentally transformed the healthcare training and education landscape, resulting in a desperate need for a system-wide exploration of scalable, flexible, user-friendly and resilient solutions that mitigate the long-term impact on the development of a skilled healthcare workforce that can deliver high-quality patient care...

Background Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest b...

Objective: To determine and analyse the temporal changes in oncologic nephrectomy practice and training opportunities using data obtained from the UK BAUS nephrectomy register from 2008 to 2017. Patient and methods: All nephrectomies within the dataset for this time period were analysed (n = 54251). Cases were divided into radical nephrectomy (R...

Objectives To present the three-year experience of the multi-component TURP module at Urology Simulation Bootcamp Course (USBC) and demonstrate trainee’s competence progression and satisfaction. Methods During the USBC, a 4-h TURP module was developed and consisted of (a) familiarisation and assembly of resectoscope instrument, (b) didactic lectur...

Objectives To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. Materials and methods We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp...

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy and transurethral resection procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool with a 9-point endourology task-specific skills and 2-point global rating skills. The to...

Objective Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes gover...

A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and radiology imaging with computed tomography (CT). Management included image-guided chest drain and...

Background: Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest...

The unparalleled epidemic of the novel coronavirus (COVID-19), during early December 2019 in Wuhan, China, has rapidly evolved into a global pandemic, became a matter of grave concern. The pandemic presented a unique challenge to government agencies worldwide. The paucity of resources and lack of knowledges to manage the pandemic, coupled with the...

Background and aims: An online teaching programme for Core Surgical Trainees (CSTs) was designed and delivered during the COVID-19 pandemic. The aim of this study is to assess the feasibility and the reception of a fully online teaching programme. Methods: Twenty teaching sessions were delivered either via Zoom™ or were pre-recorded and uploaded...

Objective: The ability to simulate procedures in silico has transformed surgical training and practice. Today's simulators, designed for the training of a highly specialized set of procedures, also present a powerful scientific tool for understanding the neural control processes that underpin the learning and application of surgical skills. Here,...

Background: Pi-score (Performance Improvement score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. Methods: The Pi-...

Report of Consultant Urology Bootcamp, November 2019

In this work, we describe a novel framework for planning and executing semi-autonomous tissue retraction in minimally invasive robotic surgery. The approach is aimed at removing tissue flaps or connective tissue from the surgical area autonomously, thus exposing the underlying anatomical structures. First, a deep neural network is used to analyse t...

Objectives: To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. Materials and methods: We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot cam...

Abstract: Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon’s initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-f...

Objective To assess the utility of simulated ward rounds to train healthcare professionals in nontechnical skills using a qualitative analysis of participant feedback. Design We developed simulated scenarios to train members of the surgical healthcare team in nontechnical skills, derived from observations of real ward rounds. Participants performe...

Background: Appendicitis is a commonly occurring condition worldwide. The gold standard treatment is appendicectomy. Although training models are commercially available for this procedure, they are often associated with high cost. Here we present a cost-effective model. Aim: To establish construct validity of a cost-effective laparoscopic append...

Objective: To assess the content validity of a low-cost bench-top model ("Raj Model") for the training of laparoscopic port insertion at the Urology Simulation Bootcamp course (USBC). Materials and methods: A low-cost abdominal wall model of 40 × 40 cm was created to simulate laparoscopic port placement. The model was made using different synthe...

Background: We report the immediate educational impact of a previously developed quality improvement (QI) curriculum for UK urology residents. Materials and methods: Prospective pre/post-training evaluation, using the Kirkpatrick framework: residents' QI knowledge, skills and attitudes were assessed via standardized assessments. We report descri...

Background: A surgical adverse incident (AI) is defined as any deviation from the normal operative course. Current complication-grading systems mostly focus on postoperative events. ~~~~~~~~~~~~~~ Objective: To propose an intraoperative AI classification (EAUiaiC) to facilitate reporting. ~~~~~~~~~~~~~~ Design, setting, and participants: The class...

Objectives: To assess the relationship of white blood cell count (WBC) and other routinely collected inflammatory and clinical markers including stone size, stone position, and medical expulsive therapy use (MET), with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic, as there are conflicting data...