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Status of robotic surgical education in urology training programs
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Does the time of day or day of the week affect outcomes after robotic radical prostatectomy? Eugene Simopolous MD, Stephen McKim MD, Angela Smith MD, Matthew Nielsen MD, Eric Wallen MD, Raj S Pruthi MD, FACS University of North Carolina at Chapel Hill, Chapel Hill, NC INTRODUCTION: Several studies have found that day of admission may affect length of stay and clinically outcomes–particularly for heart disease. This study evaluated outcomes in men undergoing robotic prostatectomy stratified by time of day and day of week. METHODS: 350 consecutive patients undergoing robotic prostatectomy were evaluated. All were performed by one of 2 surgeons, had ⬎⫽12 month follow-up, and each was classified by time of day started (am/pm) and by day of week. RESULTS: Direct comparisons and ANOVA was performed to rule out confounding factors such as surgeon affect. With regard to time of day, 254 patients were done in am and 96 in pm. There were no differences with regard to age,PSA,stage,race,OR time,EBL, or time to discharge. Interestingly, am cases had lower positive margin rate than pm cases (9% vs.17%;p⫽0.025) on chi square and ANOVA – controlling for stage, grade, surgeon, PSA, and race. There were no significant differences with regard to 12-month functional outcomes including continence or potency. With regard to day of surgery, there was no differences regarding clinical, demographic, or operative variables--except for length of stay trended longer in patients operated on Monday. Margin rates, continence or potency were not different by operative day. CONCLUSIONS: Time of day and day of week does not have a significant affect on outcomes of patients undergoing robotic prostatectomy except with regard to positive margin rates which are higher in afternoon patients. It remains unclear as to the cause of such effect but may include surgical variables, personnel effect, or pathological processing.
Robotic-assisted laparoscopic intracorporeal urinary diversion Stephen McKim MD, Eugene Simopolous MD, Mathew Raynor MD, Matthew Nielsen MD, Eric Wallen MD, Raj S Pruthi MD, FACS University of North Carolina at Chapel Hill, Chapel Hill, NC INTRODUCTION: Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. In most of these series, the urinary diversion has been performed in an extracorporeal fashion. This has been few case reports of an intracorporeal diversion, and little description of the technique of such a procedure. Herein, we report our initial experience with robotic-assisted laparoscopic intracorporeal urinary diversion describing stepwise the surgical procedure itself, and evaluating peri-operative and pathologic outcomes of this novel procedure. METHODS: Twelve patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal urinary diversion. Outcome measures evaluated in this series included operative variables, hospital recovery, and complication rate. Comparisons were made to the most recent 20 consecutive patients who underwent a robotic cystectomy with extracorporeal diversion from an experience of over 100 robotic cystectomy patients since 2005.
J Am Coll Surg
RESULTS: Mean age was 60.9 years (range 45-70 years). Nine patients underwent intracorporeal ileal conduit diversion and 3 underwent an orthotopic neobladder. Mean OR time of all patients was 5.3 hours (4.3 – 7.3 hrs) with a mean time of intracorporeal diversion of 3.0 hours. There were 6 complications in 5 patients (1 patient Clavien 3 or higher) – only one apparently related to the urinary diversion (mis-placed ureteral stent). Outcomes and comparisons to the extracorporeal diversion cohort are shown in the table. OR Time 5.3 hrs
Intracorporeal (N⫽12) Extracorporeal 4.2 hrs* (N⫽20)
Time to Time to Time to % Flatus BM DC Complication 2.2 days 3.2 days 4.5 days 42% 2.4 days
3.3 days
5.2 days
35%
CONCLUSIONS: Our initial experience with robotic intracorporeal diversion appears to be favorable with acceptable operative, and short-term clinical outcomes. As our experience increases, we should expect to continue to refine our surgical technique and reduce operating room times.
Status of robotic surgical education in urology training programs David Shore MD, Geoffrey N Box MD, Ronney Abaza MD, FACS Ohio State University Medical Center & James Cancer Hospital, Columbus, OH INTRODUCTION: While urologists involved in resident training are incorporating robotic surgery into their practices, the extent of resident training is unknown. We surveyed urology residents to evaluate the extent of robotic surgery training at their institutions. METHODS: Residents attending a didactic robotic surgery course designed specifically for trainees completed questionnaires before and after the course. Various aspects, including frequency and type of cases performed robotically, resident console time, and presence of robotic curricula were analyzed and compared with trainee perception of the adequacy of their robotic training. RESULTS: Fifty-two participants from 39 programs attended the course, with an 81% response rate. Respondents indicated that an average of 4.2 robotic surgeries per week were performed at their institutions, including 95% of programs using robotic surgery for prostatectomy. Residents perform entire cases at the console at only 24% of programs, and console time is initiated at an average level of training of PGY 4.1. A formal robotic curriculum exists at only 34% of programs and dry lab training at 54%. Only 18% of trainees indicated that they were satisfied with the extent of their robotics education. Only 38% felt that residents graduating from their programs are competent at performing robotic surgery, yet 97% planned on operating robotically upon graduation. CONCLUSIONS: Robotic surgery education at a sample of urology residency programs is variable but with overall low rates of trainee satisfaction with perceived adequacy of training. While robotic surgery is practiced at almost all of the training programs represented, propagation to trainees may be insufficient.
Does the time of day or day of the week affect outcomes after robotic radical prostatectomy? Eugene Simopolous MD, Stephen McKim MD, Angela Smith MD, Matthew Nielsen MD, Eric Wallen MD, Raj S Pruthi MD, FACS University of North Carolina at Chapel Hill, Chapel Hill, NC INTRODUCTION: Several studies have found that day of admission may affect length of stay and clinically outcomes–particularly for heart disease. This study evaluated outcomes in men undergoing robotic prostatectomy stratified by time of day and day of week. METHODS: 350 consecutive patients undergoing robotic prostatectomy were evaluated. All were performed by one of 2 surgeons, had ⬎⫽12 month follow-up, and each was classified by time of day started (am/pm) and by day of week. RESULTS: Direct comparisons and ANOVA was performed to rule out confounding factors such as surgeon affect. With regard to time of day, 254 patients were done in am and 96 in pm. There were no differences with regard to age,PSA,stage,race,OR time,EBL, or time to discharge. Interestingly, am cases had lower positive margin rate than pm cases (9% vs.17%;p⫽0.025) on chi square and ANOVA – controlling for stage, grade, surgeon, PSA, and race. There were no significant differences with regard to 12-month functional outcomes including continence or potency. With regard to day of surgery, there was no differences regarding clinical, demographic, or operative variables--except for length of stay trended longer in patients operated on Monday. Margin rates, continence or potency were not different by operative day. CONCLUSIONS: Time of day and day of week does not have a significant affect on outcomes of patients undergoing robotic prostatectomy except with regard to positive margin rates which are higher in afternoon patients. It remains unclear as to the cause of such effect but may include surgical variables, personnel effect, or pathological processing.
Robotic-assisted laparoscopic intracorporeal urinary diversion Stephen McKim MD, Eugene Simopolous MD, Mathew Raynor MD, Matthew Nielsen MD, Eric Wallen MD, Raj S Pruthi MD, FACS University of North Carolina at Chapel Hill, Chapel Hill, NC INTRODUCTION: Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. In most of these series, the urinary diversion has been performed in an extracorporeal fashion. This has been few case reports of an intracorporeal diversion, and little description of the technique of such a procedure. Herein, we report our initial experience with robotic-assisted laparoscopic intracorporeal urinary diversion describing stepwise the surgical procedure itself, and evaluating peri-operative and pathologic outcomes of this novel procedure. METHODS: Twelve patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal urinary diversion. Outcome measures evaluated in this series included operative variables, hospital recovery, and complication rate. Comparisons were made to the most recent 20 consecutive patients who underwent a robotic cystectomy with extracorporeal diversion from an experience of over 100 robotic cystectomy patients since 2005.
J Am Coll Surg
RESULTS: Mean age was 60.9 years (range 45-70 years). Nine patients underwent intracorporeal ileal conduit diversion and 3 underwent an orthotopic neobladder. Mean OR time of all patients was 5.3 hours (4.3 – 7.3 hrs) with a mean time of intracorporeal diversion of 3.0 hours. There were 6 complications in 5 patients (1 patient Clavien 3 or higher) – only one apparently related to the urinary diversion (mis-placed ureteral stent). Outcomes and comparisons to the extracorporeal diversion cohort are shown in the table. OR Time 5.3 hrs
Intracorporeal (N⫽12) Extracorporeal 4.2 hrs* (N⫽20)
Time to Time to Time to % Flatus BM DC Complication 2.2 days 3.2 days 4.5 days 42% 2.4 days
3.3 days
5.2 days
35%
CONCLUSIONS: Our initial experience with robotic intracorporeal diversion appears to be favorable with acceptable operative, and short-term clinical outcomes. As our experience increases, we should expect to continue to refine our surgical technique and reduce operating room times.
Status of robotic surgical education in urology training programs David Shore MD, Geoffrey N Box MD, Ronney Abaza MD, FACS Ohio State University Medical Center & James Cancer Hospital, Columbus, OH INTRODUCTION: While urologists involved in resident training are incorporating robotic surgery into their practices, the extent of resident training is unknown. We surveyed urology residents to evaluate the extent of robotic surgery training at their institutions. METHODS: Residents attending a didactic robotic surgery course designed specifically for trainees completed questionnaires before and after the course. Various aspects, including frequency and type of cases performed robotically, resident console time, and presence of robotic curricula were analyzed and compared with trainee perception of the adequacy of their robotic training. RESULTS: Fifty-two participants from 39 programs attended the course, with an 81% response rate. Respondents indicated that an average of 4.2 robotic surgeries per week were performed at their institutions, including 95% of programs using robotic surgery for prostatectomy. Residents perform entire cases at the console at only 24% of programs, and console time is initiated at an average level of training of PGY 4.1. A formal robotic curriculum exists at only 34% of programs and dry lab training at 54%. Only 18% of trainees indicated that they were satisfied with the extent of their robotics education. Only 38% felt that residents graduating from their programs are competent at performing robotic surgery, yet 97% planned on operating robotically upon graduation. CONCLUSIONS: Robotic surgery education at a sample of urology residency programs is variable but with overall low rates of trainee satisfaction with perceived adequacy of training. While robotic surgery is practiced at almost all of the training programs represented, propagation to trainees may be insufficient.