Assessing the current state of quality improvement training in urology in the UK: Findings from the General Medical Council 2018 trainee survey

Objective: The General Medical Council (GMC) of the UK has identified the need to support doctors through education in safety and quality improvement (QI) methods. This study reports findings from the GMC annual survey of 2018 from urology trainees regarding the state of QI training and their training needs. Material and methods: We designed a set of four questions to assess how QI methods are being taught nationally, and inserted them in the 2018 annual GMC trainee survey for urology. This is a cross-sectional study assessing the current state of QI training and mentoring received by trainees, and their self-assessed ability and confidence in completing a QI project as part of training requirements. Data were statistically analysed in Stata 15 stratified by Local Education Training Boards (LETBs)/Deanery and by specialty trainee level (ST3–7). Results: In total, 270 responses were received from urology trainees. Data showed significant variation across the country. Responses from ST3–7 trainees ranged from 5–20% on completing more than three QI projects, while 7–58% replied that they had done none. Across all ST grades, 40% of trainees stated they had not undertaken QI, whereas 0–27% reported they had not received any mentoring on QI to date. There was significant variation across training regions too: 11–74% of trainees answered that they have received training in QI methods, and 58–100% responded that they were confident in undertaking QI projects. Across all LETBs, 1–3% responded that they uploaded projects on national websites for dissemination; finally, a range of 0–18% stated they had completed more than three projects. Conclusion: This is the first national snapshot of QI training for the entire urology specialty in the UK. The study demonstrates wide variation in QI training and activity undertaken by trainees, and shows a lack of systematic implementation of QI education across training regions

The image enhanced operating environment in robot assisted laparoscopic partial nephrectomy

In the last twenty-five years surgical practice has undergone radical change. Although this change has heralded improved patient outcomes it has also presented a new set of problems centred around the reduction in sensory inputs received by the modern surgeon. A potential solution to mitigate for this sensory loss is image guidance. The thesis has its heart four guiding aims: 1) To define the window of opportunity for the development of an image guidance platform for intra-abdominal MIS. 2) To establish whether there is a user need for image guidance in RAPN. 3) To better understand the fundamental safety and behavioural implications of the implementation of an IEOE. 4) To develop and validate a novel approach to image guidance in partial nephrectomy, utilising the preceding evidence base to inform this development. The first of these aims was met, through the development of a novel metric of innovation, with the growth potential of image guidance in abdominal surgical oncology subsequently examined. The second was addressed using a qualitative survey of robotic urologists. These two studies demonstrated that image guidance in intra-abdominal surgery lies in a period of rapid innovation growth, and that demand exists for image guidance in partial nephrectomy amongst the target population. In order to meet the third of the outlined aims, two potential drawbacks of augmenting the surgeon’s intraoperative view were examined, namely: inattention blindness, and the reliability and accuracy of the most commonly used method of image preparation: segmentation. Prior to the development of the platform the limitations of existing research platforms were examined and the problems needing to be addressed for efficacious image guidance were defined as part of a systematic review into image guidance in RAPN. These problems can be distilled down to issues pertaining to: image preparation, registration, deformation compensation, and display. Informed by this review and the findings of the previous thesis chapters a dual modality platform was developed capitalising on the respective strengths of pre- and intraoperative 4 imaging to deliver an image guidance solution offering significant benefit for both planning and execution phases. Overall, this thesis has systematically devised, and evidenced a first generation dual modality image guidance platform for partial nephrectomy, meeting the differing guidance needs for specific operative steps.Open Acces

Fifty Years of Innovation in Plastic Surgery

Background Innovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years. Methods Patents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored. Results Between 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued. Conclusions The application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active

Robust ultrasound probe tracking: initial clinical experiences during robot-assisted partial nephrectomy

© 2015, CARS. Purpose: In order to assist in the identification of renal vasculature and tumour boundaries in robot-assisted partial nephrectomy, robust ultrasound probe calibration and tracking methods are introduced. Contemporaneous image guidance during these crucial stages of the procedure should ultimately lead to improved safety and quality of outcome for the patient, through reduced positive margin rates, segmental clamping, shorter ischaemic times and nephron-sparing resection. Methods: Small KeyDot markers with circular dot patterns are attached to a miniature pickup ultrasound probe. Generic probe calibration is superseded by a more robust scheme based on a sequence of physical transducer measurements. Motion prediction combined with a reduced region-of-interest in the endoscopic video feed facilitates real-time tracking and registration performance at full HD resolutions. Results: Quantitative analysis confirms that circular dot patterns result in an improved translational and rotational working envelope, in comparison with the previous chessboard pattern implementation. Furthermore, increased robustness is observed with respect to prevailing illumination levels and out-of-focus images due to relatively small endoscopic depths of field. Conclusion: Circular dot patterns should be employed in this context as they result in improved performance and robustness. This facilitates clinical usage and interpretation of the combined video and ultrasound overlay. The efficacy of the overall system is demonstrated in the first human clinical case

A mixed reality guidance system for robot assisted laparoscopic radical prostatectomy

© Springer Nature Switzerland AG 2018. Robotic surgery with preoperative imaging data for planning have become increasingly common for surgical treatment of patients. For surgeons using robotic surgical platforms, maintaining spatial awareness of the anatomical structures in the surgical area is key for good outcomes. We propose a Mixed Reality system which allows surgeons to visualize and interact with aligned anatomical models extracted from preoperative imagery as well as the in vivo imagery from the stereo laparoscope. To develop this system, we have employed techniques to 3D reconstruct stereo laparoscope images, model 3D shape of the anatomical structures from preoperative MRI stack and align the two 3D surfaces. The application we have developed allows surgeons to visualize occluded and obscured organ boundaries as well as other important anatomy that is not visible through the laparoscope alone, facilitating better spatial awareness during surgery. The system was deployed in 9 robot assisted laparoscopic prostatectomy procedures as part of a feasibility study