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(526 ⫾ 51.2 g) and tissue resistance (35.7 ⫾ 3.1 dp) of the preliminary HFLPN model was significantly higher than that seen in the porcine or human kidney. CONCLUSIONS: There is a significant difference in the tear strength of the renal capsule in differing regions of the kidney. Also, the resistance of the renal capsule overlying a renal tumor was substantially higher than normal tissues. These characteristics will be used to modify our model to ensure it will be a high fidelity training tool. These results may also be the basis of studies into tissue characteristics and haptics in virtual reality surgery. Source of Funding: None

1341 FEASIBILITY AND UTILITY OF A CLIP APPLYING EXERCISE FOR THE FUNDAMENTALS OF LAPAROSCOPIC SURGERY TECHNICAL SKILLS CURRICULUM Omer B Argun, Troy Reihsen, Minneapolis, MN; Elspeth McDougall, Irvine, CA; Robert Sweet*, Minneapolis, MN INTRODUCTION AND OBJECTIVES: In response to the charge of the AUA Laparoscopy and Robotic Surgery Committee, we examined the value of the addition of a novel clip applying exercise to the Fundamentals of Laparoscopic Surgery (FLS) technical skills curriculum. METHODS: We designed a 7-9 mm artery model and integrated a clip-applying skills task into the FLS skills exercises amongst a cohort of practicing surgeons at the Society for Laparoendoscopic Surgeons meeting 2009 (Boston, MA). Organosilicate models were molded and filled with red colored water to a mean arterial pressure of 80 ⫾ 2 mmHg. Subjects were instructed to place two 10 mm titanium clips within the black lines on both sides of the model (4 clips total), then divide the structure (Figure 1). We measured time to task, clip accuracy and assessed for leakage. Upon completion, participants filled out a survey assessing face and content aspects of validity on a 5-point likert scale. RESULTS: Thirty-seven laparoscopic surgeons (General Surgery⫽ 24, Gyn⫽ 12, Urol⫽ 1) completed the clipping exercise with a mean of 81.76⫾34.05 seconds (Std Error⫽ 5.598). Mean assessment scores from the participants are listed below (Figure 2). CONCLUSIONS: Version 1 of the clipping exercise seems to fill a basic core skill not covered by SAGES FLS Curriculum. These results encourage the future refinements of the model for further investigations.

Source of Funding: None

1342 DO LAPAROSCOPIC VR SIMULATORS DEMONSTRATE CONVERGENT VALIDITY? Omer B Argun, Troy Reihsen, Ricardo Miyaoka, Franc¸ois Sainfort, Minneapolis, MN; Michael S Kavic, Rootstown, OH; Phillip P Shadduck, Durham, NC; Robert M Sweet*, Minneapolis, MN INTRODUCTION AND OBJECTIVES: To examine convergent aspects of construct validity across four commercially available laparoscopic virtual reality (VR) simulator platforms for navigation & dissection tasks. METHODS: A single navigation & dissection task was chosen on each simulator by five experts prior to the experiment. A convenient sample of 25 multidisciplinary practicing laparoscopic surgeons participated in a study in which they performed navigation and/or dissection tasks on one or more of four simulators (Haptica ProMIS, METI SurgicalSim VR, Simbionix LAPMentor and Surgical Science LapSim (with & without haptic force-feedback). Subjects rotated at each simulator for 10 minutes. Performance metrics (navigation task completion time & path lengths; dissection task completion time) were logged on all simulators & uploaded for subsequent analysis. Data were cleaned using outlier analysis and tested for normality. Both Pearson & rankorder Spearman correlation analyses were used to analyze the performance data. RESULTS: For navigation task completion time, correlation coefficients were moderate to high (Pearson 0.619-0.807, Spearman 0.258-0.810) between Haptica, Simbionix, & Surgical Science Haptic. For navigation task path lengths, there was minimal correlation between simulators (Spearman x-0.476). For dissection task completion time, small to moderate correlations were found between Surgical Science Haptics and Haptica, METI, & Simbionix. CONCLUSIONS: Practicing laparoscopic surgeons performed similarly in comparison to their peers on navigation and dissection tasks across four commercially available laparoscopic VR simulation platforms containing force-feedback. There is small to moderate and moderate to strong correlation for navigation and dissection skills respectively. As convergence contributes to construct validity, this study strengthens the claims of construct validity for navigation and dissection tasks on these simulators. Source of Funding: None

1343 EVALUATION OF LAPAROSCOPIC CURRICULA IN AMERICAN UROLOGY RESIDENCY TRAINING Behfar Ehdaie*, Chris Reynolds, Charlottesville, VA; Chad Tracy, Iowa City, IA; Noah Schenkman, Charlottesville, VA INTRODUCTION AND OBJECTIVES: Surgical residency training is changing and curricula are being developed that incorporate

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simulators to enhance laparoscopic experience. We evaluated the evolution of laparoscopic curricula in urology training programs over the past two years from the perspectives of residents. METHODS: After IRB approval, an anonymous survey was developed and given to urology residents attending the AUA Basic Sciences Course in June 2008 and 2009. The AUA region of program, laparoscopic surgical experience, and the status of simulators at each institution were surveyed. We evaluated laparoscopic simulator use within a curriculum and use of simulators outside and independent of a curriculum. Face and content validity of simulators were analyzed on a 5-point Likert scale questionnaire. Responses were compared using the unpaired Student’s T-test and Chi-Squared with p⬍0.05 considered significant. RESULTS: 114 surveys (81.4% response rate) and 76 surveys (43% response rate) were evaluated from 2008 and 2009, respectively. All 8 sections of the AUA were represented in each year. Over the one year period, access to a surgical simulator increased from 74.6% to 78%. The percentage of programs with a laparoscopic curriculum expanded from 16.9% to 44%. In 2009, simulators were used more frequently by residents in programs with curricula compared to residents without curricula (p⫽0.03). In 2008, residents reported more frequent simulator use compared to 2009 (p⫽0.001). However, 48% of residents in 2008 and 72% in 2009, still reported using simulators as “never” or “once or twice a year”. The laparoscopic box trainer was the most frequently used simulator in 2008 (60%) and 2009 (47%). 35% of curricula incorporate simulators “once a month” and 4% “every other week”. 93% of residents stated that urology programs should use laparoscopic curricula and 82% of this group thinks simulators should be involved in curricula. Residents rated simulators as very helpful for operative skill acquisition and described their current laparoscopic training curriculum as inadequate. CONCLUSIONS: The number of urology programs that have invested in simulators continues to expand. Concurrently, more residency programs have adopted a laparoscopic curriculum. Despite access to laparoscopic simulators, residents rarely use them. Residents in programs with a laparoscopic curriculum use simulators more often outside of the requirements of their curriculum than residents without a curriculum. From the perspective of residents, laparoscopic curricula are important and the incorporation of simulators enhances surgical education. Source of Funding: University of Virginia: Young Scientist Award

1344 THE IMPACT OF THE ALEXANDER TECHNIQUE IN IMPROVING POSTURE DURING MINIMALLY INVASIVE SURGERY. Pramod Reddy*, Trisha Reddy, Paul Noh, Krishnanath Gaitonde, Cincinnati, OH INTRODUCTION AND OBJECTIVES: One of the main ergonomic challenges during surgical procedures is the surgeon’s posture. Under ideal circumstances during surgery the surgeon’s posture would be completely static; such non-movement is not only impossible to maintain but is also impractical. This issue is further compounded during the performance of minimally invasive surgery (MIS) where the surgeon sometimes assumes an awkward posture during the procedure. The Alexander technique (AT) is a process of psychophysical re-education of one’s body in order to improve postural balance and co-ordination. The purpose of this study is to evaluate the efficacy of the AT in improving posture during the performance of MIS. METHODS: We performed a prospective study in which each subject served as their own control. After obtaining IRB approval, a total of eight test subjects were recruited from Urology training program. All subjects underwent the following: PreAT-Test of Basic Laparoscopic skill assessment, PreAT-Test of Postural Co-ordination, Planned intervention - a total of 8 AT sessions with an AmSAT instructor, PostATtest of Basic Laparoscopic skill assessment, PostAT-Test of Postural Co-ordination. The subjective and objective data was recorded. The

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data was tabulated and analyzed with descriptive statistics (GraphPad), to determine if the PreAT and the PostAT scores were significantly different. RESULTS: All subjects reported a subjective improvement in their overall posture. There was a statistically significant difference in the PostAT posture scores for the neck, spine, shoulders, hands and fingers (P values ranged from 0.019 – 0.026). While we did record a difference in the blood pressure (BP) of the subjects, the PostAT BP did not show statistical significance. The subjects did demonstrate improved ergonomics and improved ability to complete the skill sets, with the PostAT load time test, suturing and cutting demonstrating statistically significant differences (P values ranged from 0.0178 – 0.02). CONCLUSIONS: The AT training program resulted in a significant improvement in posture, trunk endurance and surgical ergonomics from pre-training to post-training, accompanied by reduction in perceived discomfort when performing the basic laparoscopic skill assessment. Future studies investigating the influence of AT on surgical ergonomics during laparoscopic procedures are recommended as this will aid our understanding of the benefits afforded by the AT and allow its implementation into other aspects of surgery. Source of Funding: None

1345 AUTOFLUORESCENCE MICROSCOPY OF PERIPROSTATIC LYMPHATIC TISSUE AND CORRELATION WITH CONVENTIONAL HISTOPATHOLOGY IMAGING. Ashutosh Tewari*, Mike Herman, Sushmita Mukherjee, Rajiv Yadav, Sonal Grover, Kumaran Mudaliar, Youssef El Douaihy, Fred Maxfield, Mark Rubin, Abhishek Srivastava, David Peters, Warren R Zipfel, DaWei Ye, Gerald Tan, Robert Leung, Josh Sterling, Watt W Webb, New York, NY INTRODUCTION AND OBJECTIVES: This was a prospective study involving imaging and histopathological correlations of human prostate and extra-prostatic lymphatic tissue to validate our hypothesis that laser imaging (Robo-Microscopy Project) is a minimally invasive imaging modality that provides both cellular and extracellular structural information with subcellular resolution and can be used for intraoperative imaging in future METHODS: We imaged a palpable lymph node that had been removed with the prostate. The imaging was carried out using intrinsic fluorescence and scattering properties of the tissues without any exogenous dye or contrast agent (Robo-Microscopy-Project). A custombuilt femtosecond pulsed titanium/sapphire laser at 780-nm wavelength was used to excite the tissue; laser power under the objective was modulated via a Pockels cell. Signals were collected at 390 (⫹/-35 nm), and broadband autofluorescence was collected at 380 to 530 nm. In certain cases, longer wavelength autofluorescence was collected at 530-650 nm. The images obtained from tissue fluorescence were then merged and color coded during post processing for better appreciation of details. The corresponding tissues were subjected to hematoxylin and eosin staining for histological confirmation of the structures. RESULTS: We identified some non-glandular structures within the prostate. These structures are visually distinct from arteries, and veins; close examination of the diagnostic pathology suggests that these may in fact be lymphovascular spaces (fig 1). In Robo-Microscopy Project image of the dissected lymph nodes we observed an interconnecting network of autofluorescent vessels surrounding clusters of what appeared to be cells. Based on the appearance of the lymphovascular spaces we observed in the prostatic slices, we believe this network of autofluorescent vessels represents the lymph channels within the node. The H&E pathology of the same pelvic lymph node demonstrates collagenous septa; very little SHG signal was apparent, however. CONCLUSIONS: Robo-Microscopy Project imaging has a great potential for application in the in vivo real time intraoperative imaging of the tissues, and may alleviate the need for intraoperative frozen sections in future.