- Email: [email protected]
MP-08.06: Laparoscopic Technique Training Program in Urology
MODERATED POSTER SESSIONS
operatively to (16.5⫾1.5) ml/s postoperatively. IPSS and QoL-Score improved from 28.6⫾5.5 to 8.3⫾2.3 and 4.5⫾0.4 to 2.7⫾0.2 respectively (P⬍0.05). Conclusions: RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia is a safe and effective relief from obstructive BPH with minimal morbidity and rare bleeding, and that, in combination with enucleation, may improve the efficiency of vaporesection.
MP-08.04 Six-Step Training Program for Residents to Perform Anatomic Retroperitoneoscopic Adrenalectomy: A Safe Approach to Learning Ma X1, Xu Z1, Wang B2, Li H1, Shi T2, Ju Z2, Wang C2, Zhang G2, Ai X2 1 Department of Urology, 301 Hospital, Beijing, China; 2Department of Urology, Tongji Hospital/Medical College, Huazhong University of Science and Technology, Beijing, China Introduction and Objective: To establish a training program for residents with no previous laparoscopic experience to perform anatomic retroperitoneoscopic adrenalectomy (ARA) and evaluate its safety and efficiency. Materials and Methods: Based on the six segments of key techniques of ARA, a teaching schedule was designed. Thus we established a six-step training program where the residents learned the procedure in a mentor-initiated approach. Five residents with no previous laparoscopic experience joined the program. On intensive laboratory training received or not before the program, they were classified into group A (no) and group B (yes). During the training, the trainees acted as camera holder firstly. Subsequently, they repeatedly performed each step in the schedule, which was assisted by the mentor who performed the remaining steps of the procedure. Only when their performance satisfied the mentor, could they do the next step. Finally, they performed 30 procedures independently by supervision of the mentor. Results: The mean total repeats required by group A was more than group B (41.4 vs. 30, p⫽0.03). The mean operative time (OT), estimated blood loss and complications of the 30 procedures were not significantly different among group A, B and the mentor. Though the OT of the second15 procedures of group A and B were longer than that of the mentor (p⫽0.035, p⫽0.049, respectively), there was a still
steeper learning curve compared with the mentor. Conclusions: The six-step training program was efficient to transfer the key techniques of ARA to the trainees without compromising patient care. MP-08.05 Tips and Techniques in the Treatment of Major Vessel Injury in Laparoscopic Surgery Fu B, Wang G, Sun T, Cui S, Feng L, Cao R No.1 Hospital Affiliated To Nanchang University, Nanchang, China Introduction and Objective: Major vessel injury is a severe complication in laparoscopic surgery. An important lesson for any laparoscopic surgeon should be how to prevent and treat it. Here we introduce our experience in the treatment of major vessel injury in urinary laparoscopic operations. Materials and Methods: From October 2005 to March 2008, 4 patients had the complications of major vessels laceration in the laparoscopic surgery, including 2 cases in retroperitoneal laparoscopic radical nephrectomy (about 0.2cm and 0.5cmlong laceration in the anterior wall of IVC), 1 in laparoscopic renal pedicle lymphatic duct ligation (two 0.1cm lacerations in the junction between renal vein and IVC), and 1 in right adrenalectomy(about 0.3cm-long split in IVC adjacent to liver) . The injuries occurred in combination with the existence of severe adherence in the operative field. Under the CO2 pressure of 12-15mmHg, little vascular injury with little bleeding could be closed with 8 figure suture, and the injury with significant bleeding should be pressed with gauze ball and sutured while exposing the laceration by and by. Results: Only 1 was converted to open surgery because of large laceration (0.5cm in size) in the anterior wall of IVC and un-controlled bleeding in radical nephrectomy. Other 3 intracorporal vascular laceration repairs were completed successfully. During more than one year follow-up, the 4 patients recovered evenly. Conclusions: When performing in laparoscopic surgery, gentle and meticulous dissection should be preceded in clear operative fields in certain anatomic planes, especially near the major vessels. Once major vascular injury occurred incidentally, the surgeons should keep calm and perform intracorporal suturing and knotting to close the splits. If necessary, conversion should be done immediately without any doubt.
UROLOGY 74 (Supplment 4A), October 2009
MP-08.06 Laparoscopic Technique Training Program in Urology Xu Z1, Ai X2, Ma X1, Li H1, Ju Z2, Wang C2, Shi T2, Zhang G2, Wang B2 1 Department of Urology, China PLA General Hospital, Beijing, China; 2Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Introduction and Objective: To validate a new standardized training program for urologic surgeon to improve their laparoscopic skills. Materials and Methods: The laparoscopic training program was carried out on a traditional mechanical simulator and some animal models. Thirty three trainees participated in the urologic laparoscopic training program. The novices was arranged to practise basic laparoscopic skills step by step in the simulator with fixed trocar positions at first; they could perform simulation training on the animal models after a period of basic training. Results: All trainees (33/33, 100.0%) participated were able to perform all basic steps skillfully and complete laparoscopic anastomosis accurately after training. The time required for performing the partial nephrectomy, dismembered pyeloplasty and ureteral reimplantation on the animal model declined from (64.0⫾18.4), (127.5⫾17.5) and (75.8⫾11.6)min initially to(30.9⫾3.8), (65.2⫾7.5) and (37.7⫾7.2)min after the trainees had performed these surgery eight times(P⬍0.01). They could grasp the main points of the laparoscopic operating procedure after six to eight special training on the animal models. Fifteen trainees (15/33, 45.5%) had carried out laparoscopic surgery after our training program. Conclusions: Our program enabled the participants increase their performance in complicated laparoscopy. And the results indicate that the challenging parts of reconstructive laparoscopy such as laparoscopic dismembered pyeloplasty can be taught by animal models. This experience could be incorporated easily by every department developing a laparoscopic training program. MP-08.07 The Effect of Multiple Renal Arteries on the Outcomes of Laparoscopic Living Donor Nephrectomy Kuo T1, Cheng C1, Yip S2 1 Department of Urology, Singapore General Hospital, Singapore; 2Division of Urology, Department of Surgery, Chinese University Hong Kong, Hong Kong, SAR
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operatively to (16.5⫾1.5) ml/s postoperatively. IPSS and QoL-Score improved from 28.6⫾5.5 to 8.3⫾2.3 and 4.5⫾0.4 to 2.7⫾0.2 respectively (P⬍0.05). Conclusions: RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia is a safe and effective relief from obstructive BPH with minimal morbidity and rare bleeding, and that, in combination with enucleation, may improve the efficiency of vaporesection.
MP-08.04 Six-Step Training Program for Residents to Perform Anatomic Retroperitoneoscopic Adrenalectomy: A Safe Approach to Learning Ma X1, Xu Z1, Wang B2, Li H1, Shi T2, Ju Z2, Wang C2, Zhang G2, Ai X2 1 Department of Urology, 301 Hospital, Beijing, China; 2Department of Urology, Tongji Hospital/Medical College, Huazhong University of Science and Technology, Beijing, China Introduction and Objective: To establish a training program for residents with no previous laparoscopic experience to perform anatomic retroperitoneoscopic adrenalectomy (ARA) and evaluate its safety and efficiency. Materials and Methods: Based on the six segments of key techniques of ARA, a teaching schedule was designed. Thus we established a six-step training program where the residents learned the procedure in a mentor-initiated approach. Five residents with no previous laparoscopic experience joined the program. On intensive laboratory training received or not before the program, they were classified into group A (no) and group B (yes). During the training, the trainees acted as camera holder firstly. Subsequently, they repeatedly performed each step in the schedule, which was assisted by the mentor who performed the remaining steps of the procedure. Only when their performance satisfied the mentor, could they do the next step. Finally, they performed 30 procedures independently by supervision of the mentor. Results: The mean total repeats required by group A was more than group B (41.4 vs. 30, p⫽0.03). The mean operative time (OT), estimated blood loss and complications of the 30 procedures were not significantly different among group A, B and the mentor. Though the OT of the second15 procedures of group A and B were longer than that of the mentor (p⫽0.035, p⫽0.049, respectively), there was a still
steeper learning curve compared with the mentor. Conclusions: The six-step training program was efficient to transfer the key techniques of ARA to the trainees without compromising patient care. MP-08.05 Tips and Techniques in the Treatment of Major Vessel Injury in Laparoscopic Surgery Fu B, Wang G, Sun T, Cui S, Feng L, Cao R No.1 Hospital Affiliated To Nanchang University, Nanchang, China Introduction and Objective: Major vessel injury is a severe complication in laparoscopic surgery. An important lesson for any laparoscopic surgeon should be how to prevent and treat it. Here we introduce our experience in the treatment of major vessel injury in urinary laparoscopic operations. Materials and Methods: From October 2005 to March 2008, 4 patients had the complications of major vessels laceration in the laparoscopic surgery, including 2 cases in retroperitoneal laparoscopic radical nephrectomy (about 0.2cm and 0.5cmlong laceration in the anterior wall of IVC), 1 in laparoscopic renal pedicle lymphatic duct ligation (two 0.1cm lacerations in the junction between renal vein and IVC), and 1 in right adrenalectomy(about 0.3cm-long split in IVC adjacent to liver) . The injuries occurred in combination with the existence of severe adherence in the operative field. Under the CO2 pressure of 12-15mmHg, little vascular injury with little bleeding could be closed with 8 figure suture, and the injury with significant bleeding should be pressed with gauze ball and sutured while exposing the laceration by and by. Results: Only 1 was converted to open surgery because of large laceration (0.5cm in size) in the anterior wall of IVC and un-controlled bleeding in radical nephrectomy. Other 3 intracorporal vascular laceration repairs were completed successfully. During more than one year follow-up, the 4 patients recovered evenly. Conclusions: When performing in laparoscopic surgery, gentle and meticulous dissection should be preceded in clear operative fields in certain anatomic planes, especially near the major vessels. Once major vascular injury occurred incidentally, the surgeons should keep calm and perform intracorporal suturing and knotting to close the splits. If necessary, conversion should be done immediately without any doubt.
UROLOGY 74 (Supplment 4A), October 2009
MP-08.06 Laparoscopic Technique Training Program in Urology Xu Z1, Ai X2, Ma X1, Li H1, Ju Z2, Wang C2, Shi T2, Zhang G2, Wang B2 1 Department of Urology, China PLA General Hospital, Beijing, China; 2Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Introduction and Objective: To validate a new standardized training program for urologic surgeon to improve their laparoscopic skills. Materials and Methods: The laparoscopic training program was carried out on a traditional mechanical simulator and some animal models. Thirty three trainees participated in the urologic laparoscopic training program. The novices was arranged to practise basic laparoscopic skills step by step in the simulator with fixed trocar positions at first; they could perform simulation training on the animal models after a period of basic training. Results: All trainees (33/33, 100.0%) participated were able to perform all basic steps skillfully and complete laparoscopic anastomosis accurately after training. The time required for performing the partial nephrectomy, dismembered pyeloplasty and ureteral reimplantation on the animal model declined from (64.0⫾18.4), (127.5⫾17.5) and (75.8⫾11.6)min initially to(30.9⫾3.8), (65.2⫾7.5) and (37.7⫾7.2)min after the trainees had performed these surgery eight times(P⬍0.01). They could grasp the main points of the laparoscopic operating procedure after six to eight special training on the animal models. Fifteen trainees (15/33, 45.5%) had carried out laparoscopic surgery after our training program. Conclusions: Our program enabled the participants increase their performance in complicated laparoscopy. And the results indicate that the challenging parts of reconstructive laparoscopy such as laparoscopic dismembered pyeloplasty can be taught by animal models. This experience could be incorporated easily by every department developing a laparoscopic training program. MP-08.07 The Effect of Multiple Renal Arteries on the Outcomes of Laparoscopic Living Donor Nephrectomy Kuo T1, Cheng C1, Yip S2 1 Department of Urology, Singapore General Hospital, Singapore; 2Division of Urology, Department of Surgery, Chinese University Hong Kong, Hong Kong, SAR
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