Surgical suturing training with virtual reality simulation versus dry lab practice: an evaluation of performance improvement, content, and face validity

The purpose of this study is to evaluate the effectiveness of virtual reality (VR) simulation versus dry lab suturing practice at improving suturing performance in robotic surgery. Nineteen novice participants with no prior robotic suturing experience were randomized to two groups, VR simulation and dry lab, which consisted of inanimate training on a da Vinci Si surgical system. Each group underwent baseline suturing evaluation, then trained on the Simbionix™ Suturing Module (SSM) or undertook suturing practice using the da Vinci Surgical System in a dry lab. Final suturing performance was evaluated using the objective suture scoring method. Participants in the VR simulation group were surveyed to assess the face and content validity of the SSM. Both groups experienced significant improvement after training (VR simulation group p = 0.0078; dry lab group p = 0.0039). There was no significant difference in improvement between the two groups after undergoing training with either SSM or in the dry lab. Improvements in composite timing scores were 123 and 172 in the VR simulation and dry lab test groups, respectively (p = 0.36). Face validation varied with respect to the category assessed, but participants confirmed content validity of the SSM in all categories. In this sample of novice operators, there was no significant advantage in training with VR simulation using the SSM over dry lab training in improving suturing performance. Users of the SSM found it useful and relevant as a training tool for improving suturing performance

Robotic dismembered pyeloplasty in a horseshoe kidney after failed endopyelotomy.

We report our experience performing a robot-assisted dismembered pyeloplasty on a patient with a ureteropelvic junction obstruction in a horseshoe kidney and a prior history of endopyelotomy. We provide 18-month follow-up demonstrating that robotic pyeloplasty is a reasonable second treatment option for patients with horseshoe kidneys with failed prior endourological management

The minimally invasive treatment of ureteropelvic junction obstruction: a review of our experience during the last decade.

PURPOSE: The minimally invasive treatment of ureteropelvic junction obstruction has evolved during the last decade from endoscopic to laparoscopic and robotic. We review our 10-year experience with ureteropelvic junction obstruction, and report on our experience and followup. MATERIALS AND METHODS: We reviewed all patients treated during the last 10 years. There were 294 procedures performed with complete records on 273 patients including 128 retrograde endopyelotomies, 116 laparoscopic pyeloplasties and 29 robotic pyeloplasties. Technique for each procedure is reviewed. Statistical analysis was performed on all results. Variables evaluated were gender, age (younger than 41 vs 41 years or older), side (right or left), presence of crossing vessels, presence of a high insertion, primary or secondary procedure and whether prior endopyelotomy or pyeloplasty had been performed. RESULTS: Mean followup for endopyelotomy, laparoscopic pyeloplasty and robotic pyeloplasty was 20, 20 and 19 months, respectively, with success rates of 60.2%, 88.8% and 100%, respectively. On univariable analysis only the presence of crossing vessels or a high insertion was significant for laparoscopic pyeloplasty. On multivariable analysis age was significant for endopyelotomy and the presence of crossing vessels was significant for pyeloplasty. On Kaplan-Meier analysis failures were noted to occur after 5 years in both groups. CONCLUSIONS: Laparoscopic pyeloplasty and robotic pyeloplasty are superior minimally invasive treatments for ureteropelvic junction obstruction. However, endopyelotomy can be used for select patients. Because of late failures patients who undergo either of these procedures should receive long-term followup

Clinical Influences in the Multidisciplinary Management of Small Renal Masses at a Tertiary Referral Center

Introduction We designed a multidisciplinary Small Renal Mass Center to help patients decide among treatment options and individualize therapy for small renal masses. In this model physicians and support staff from multiple specialties work as a team to evaluate and devise a treatment plan for patients at the same organized visit. Methods We retrospectively reviewed the records of 263 patients seen from 2009 to 2014. Monitored patient characteristics included age, Charlson comorbidity index, body mass index, nephrometry score, tumor size and estimated glomerular filtration rate. Univariate and multivariate analyses were performed to identify patient characteristics associated with each treatment choice. Results Of the cohort 88 patients elected active surveillance, 64 underwent ablation and 111 were treated with surgery, including partial and radical nephrectomy in 74 and 37, respectively. There were significant associations between treatment modality and age, Charlson comorbidity index, tumor size and estimated glomerular filtration rate. Mean patient age at presentation was 61.1 years. Patients with a high Charlson comorbidity index score (greater than 5) or a decreased estimated glomerular filtration rate (less than 60 ml/minute/1.73 m2) were more likely to undergo active surveillance (41.6% and 35%) and ablative therapy (29.6% and 34%) vs partial nephrectomy (10.6% and 9%, respectively, each p \u3c0.001). On multivariable analysis age, tumor size and estimated glomerular filtration rate remained significantly associated with modality after adjustment for all other factors (each p \u3c0.001). Conclusions The Small Renal Mass Center enables patients to assess the various treatment modalities for a small renal mass in a single setting. By providing simultaneous access to the various specialists it provides an invaluable opportunity for informed patient decision making. © 2016 American Urological Association Education and Research, Inc

The effects of fatigue on robotic surgical skill training in Urology residents

This study reports on the effect of fatigue on Urology residents using the daVinci surgical skills simulator (dVSS). Seven Urology residents performed a series of selected exercises on the dVSS while pre-call and post-call. Prior to dVSS performance a survey of subjective fatigue was taken and residents were tested with the Epworth Sleepiness Scale (ESS). Using the metrics available in the dVSS software, the performance of each resident was evaluated. The Urology residents slept an average of 4.07 h (range 2.5-6 h) while on call compared to an average of 5.43 h while not on call (range 3-7 h, p = 0.08). Post-call residents were significantly more likely to be identified as fatigued by the Epworth Sleepiness Score than pre-call residents (p = 0.01). Significant differences were observed in fatigued residents performing the exercises, Tubes and Match Board 2 (p = 0.05, 0.02). Additionally, there were significant differences in the total number of critical errors during the training session (9.29 vs. 3.14, p = 0.04). Fatigue in post-call Urology residents leads to poorer performance on the dVSS simulator. The dVSS may become a useful instrument in the education of fatigued residents and a tool to identify fatigue in trainees

Robotic-assistance does not enhance standard laparoscopic technique for right-sided donor nephrectomy.

OBJECTIVE: To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN. MATERIALS & METHODS: From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes. RESULTS: Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4 mL vs. 30 mL, P = .07) nor operative time (231 min vs. 218 min, P = .61) were significantly different between either group (LDN vs. RALDN). Warm ischemia time for LDN was 2.6 min vs. 3.8 min for RALDN (P = .44). Donor postoperative serum estimated glomerular filtration rates (eGFR) were similar (53 vs. 59.6 mL/min/1.73 m2, LDN vs. RALDN, P = .26). For the recipient patients, posttransplant eGFR were similar at 6 months (53.4 vs. 59.8 mL/min/1.73 m2, LDN vs. RALDN, P = .53). CONCLUSION: In this study, robotic-assistance did not improve outcomes associated with LDN. Larger prospective studies are needed to confirm any perceived benefit of RALDN

Urolithiasis location and size and the association with microhematuria and stone-related symptoms.

PURPOSE: To conduct a study to assess the association between calculus location and size and the incidence of both microhematuria and symptoms of urolithiasis in a urology office environment. PATIENTS AND METHODS: After Institutional Review Board approval, a prospective study was conducted with data from 100 consecutive patients who presented to our office with documented urolithiasis. The location (caliceal, pelvic, or ureteral) and size ( RESULTS: A total of 111 stones were found in the study population resulting in a 45.9% incidence of microhematuria. In patients with renal pelvic and ureteral stones, 67.6% demonstrated microhematuria vs 36.4% with caliceal stones, P=0.0035. For stones ≥ 8 mm, 62.5% were positive for microhematuria vs 29.1% of stones \u3c8 \u3emm, P=0.0006. Ureteral or renal pelvic stones caused the most symptoms (70.6%) compared with caliceal stones (16.9%), P=0.0001. In those patients who reported pain associated with urolithiasis, 65.6% had concomitant microhematuria vs 36.8% in those without pain, P=0.0097. CONCLUSIONS: Urinary calculus location and size are associated with the incidence of microhematuria and stone-related symptoms. Pain related to urolithiasis may be a positive predictor for the presence of microhematuria

Robotic surgery training with commercially available simulation systems in 2011: a current review and practice pattern survey from the society of urologic robotic surgeons.

Abstract Objectives: Virtual reality (VR) simulation has the potential to standardize surgical training for robotic surgery. We sought to evaluate all commercially available VR robotic simulators. Materials and Methods: A MEDLINE(®) literature search was performed of all applicable keywords. Available VR simulators were evaluated with regard to face, content, and construct validation. Additionally, a survey was e-mailed to all members of the Endourological Society, querying the pervasiveness of VR simulators in robotic surgical training. Finally, each company was e-mailed to ask for a price quote for their respective system. Results: There are four VR robotic surgical simulators currently available: RoSS™, dV-Trainer™, SEP Robot™, and da Vinci(®) Skills Simulator™. Each system is represented in the literature and all possess varying degrees of face, content, and construct validity. Although all systems have basic skill sets with performance analysis and metrics software, most do not contain procedural components. When evaluating the results of our survey, most respondents did not possess a VR simulator although almost all believed there to be great potential for these devices in robotic surgical training. With the exception of the SEP Robot, all VR simulators are similar in price. Conclusions: VR simulators have a definite role in the future of robotic surgical training. Although the simulators target technical components of training, their largest impact will be appreciated when incorporated into a comprehensive educational curriculum