ORSI Academy

Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms. An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant. A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users. Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

Minimally invasive treatments (MITs) have emerged as viable treatment options for carefully selected patients with localized disease. Their major advantage is that MITs enable the preservation of nearby healthy prostate tissue and critical structures such as the urethral sphincter and neurovascular bundles without compromising oncologic outcomes. The aim of the current review is to describe the impact of different MITs for prostate cancer (PCa) on urinary continence. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: all clinical trials conducted and related to the urinary outcomes (UO) of PCa MITs. Exclusion criteria were as follows: any reviews, articles, conference abstracts, articles whose subject fell outside the scope of this review, or any articles published more than 5 years ago. In the course of the last 5 years, a total of 114 articles on MITs of PCa have been published. Among them, only 36 dealt with the UO for MITs. Brachytherapy, cryoablation, and high-intensity focused ultrasound (HIFU) seem to be the most widely used technologies, whereas irreversible electroporation, focal brachytherapy, focal cryoablation, and multi-parametric magnetic resonance imaging-ultrasound-guided (mpMRI-US-guided) HIFU seem to be the safest techniques in terms of UO. The use of MITs for treating PCa is a fast-growing option that can help preserve functional parameters and urinary continence close to their normal levels. It should be noted that although there are currently limited data available on all MITs for the treatment of PCa, the ones that have been extensively studied have shown promising results.

Proficiency based progression (PBP) is a very effective method of training and has been adopted by the European Robotic Surgical Section (ERUS) for robotic skills training. No study has addressed whether all learners can be trained to the proficiency benchmark. In this study, we evaluated: 1) if all trainees reached a quantitatively defined proficiency benchmark for a robotic suturing and knot tying anastomosis task; and 2) the number of training trials required. In a multi-center, prospective, randomized, study, 48 participants were randomized to: 1) a PBP group that received e-learning on the ORSI chicken anastomosis task with the requirement to reach the proficiency benchmark before starting practical training; 2) e-learning group, received the exact same curriculum as group 1, but with no proficiency requirement on the e-learning; 3) traditional group received the exact same curriculum in face-to-face lectures; 4) the apprenticeship group received a conventional preparation. All participants, except five in group 4, demonstrated the proficiency benchmark. Group 1 took ~6 trials (~3 hours); group 2 required 14% longer, group 3, 103% (P<0.001) and in group 4, 58% of trainees demonstrated the benchmark but took 162% (P<0.001) longer. This was a small-scale but robust study with substantial effect sizes. All PBP trainees demonstrated the proficiency benchmark in comparison to 58% of conventional trained group. As adherence to the PBP methodology decreased, the efficiency of proficiency demonstration significantly reduced.

External ventricular drain (EVD) placement is often performed freehand, a technique subpar to accurate yet impractical image-guided methods, yielding optimal placement in only 70%. The aim of this study was to address shortcomings in EVD placement and image guidance technologies by implementing high-accuracy augmented reality (AR) guidance. We conducted a prospective clinical pilot study to assess feasibility, safety, and clinical performance of EVD placement using a standalone AR headset equipped with high-accuracy inside-out infrared tracking and software addressing EVD placement. Placement quality was reported using a newly defined extended modified Kakarla scale, and dichotomized into clinically relevant outcome parameters. Results were compared with a nonconcurrent freehand control group using one-sided Fisher exact tests. Eleven AR-guided EVD placements were performed, achieving functional placement in all cases on the first attempt, vs 7 (64%) in the control group ( P = .045); successful placement in 9 (82%) vs 5 (45%); optimal in 8 (73%) vs 3 (27%) ( P = .043); suboptimal in 2 (18%) vs 5 (45%); and failed in 0 vs 1 (9%). No AR-guided placements required revision, whereas the freehand group had a 36% reintervention rate ( P = .045). Procedure-related complications occurred in 2 AR-guided cases (18%), vs 5 (45%) freehand (all post-reintervention). This study presents the first clinical use case of EVD placement using high-accuracy AR guidance contained in a standalone head-worn navigation system. Safe and reliable outcomes using a validated pipeline were demonstrated, eliminating stick-and-poke attempts and resulting in improved quality, increased single attempt success rates, and reduced revision and complication rates. Based on these results, a multicenter randomized controlled trial will be initiated.

Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases.