A methodological, task-based approach to Procedure-Specific Simulations training.

Journal of EndourologyVol. 22, No. 9 Tricks of the TradeRobotic Urethrovesical Anastomosis: Combining Running and Interrupted SuturesAlexander M. Berry, Fernando Korkes, Marcos Ferreira, and Jim C. HuAlexander M. BerrySearch for more papers by this author, Fernando KorkesSearch for more papers by this author, Marcos FerreiraSearch for more papers by this author, and Jim C. HuSearch for more papers by this authorPublished Online:23 Sep 2008https://doi.org/10.1089/end.2008.0099AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byThe Urethrovesical Anastomosis3 March 2018Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: A parallel comparative trialUrologic Oncology: Seminars and Original Investigations, Vol. 34, No. 12Neoadjuvant Systemic Therapy Before Radical Prostatectomy in High-Risk Prostate Cancer Does Not Increase Surgical Morbidity: Contemporary Results Using the Clavien SystemClinical Genitourinary Cancer, Vol. 14, No. 2The Transperitoneal Robotic-Assisted Radical Prostatectomy26 October 2013Does the Use of a Barbed Polyglyconate Absorbable Suture Have an Impact on Urethral Anastomosis Time, Urethral Stenosis Rates, and Cost Effectiveness During Robot-assisted Radical Prostatectomy?Urology, Vol. 82, No. 1The Urethrovesical Anastomosis28 February 2013Anastomosis During Robot-assisted Radical Prostatectomy: Randomized Controlled Trial Comparing Barbed and Standard Monofilament SutureUrology, Vol. 78, No. 3The Impact of Prostate Size, Median Lobe, and Prior Benign Prostatic Hyperplasia Intervention on Robot-Assisted Laparoscopic Prostatectomy: Technique and OutcomesEuropean Urology, Vol. 59, No. 4Athermal Division and Selective Suture Ligation of the Dorsal Vein Complex During Robot-Assisted Laparoscopic Radical Prostatectomy: Description of Technique and OutcomesEuropean Urology, Vol. 59, No. 2Randomized Controlled Trial of Barbed Polyglyconate Versus Polyglactin Suture for Robot-Assisted Laparoscopic Prostatectomy Anastomosis: Technique and OutcomesEuropean Urology, Vol. 58, No. 6A Novel Method of Urethrovesical Anastomosis During Robot-Assisted Radical Prostatectomy Using a Unidirectional Barbed Wound Closure Device: Feasibility Study and Early Outcomes in 51 Patients Sanjeev Kaul, Jesse Sammon, Akshay Bhandari, James Peabody, Craig G. Rogers, and Mani Menon3 November 2010 | Journal of Endourology, Vol. 24, No. 11Current World LiteratureCurrent Opinion in Urology, Vol. 20, No. 2Overcoming the Learning Curve for Robotic-assisted Laparoscopic Radical ProstatectomyUrologic Clinics of North America, Vol. 37, No. 1Anatomic Bladder Neck Preservation During Robotic-Assisted Laparoscopic Radical Prostatectomy: Description of Technique and OutcomesEuropean Urology, Vol. 56, No. 6 Volume 22Issue 9Sep 2008 InformationMary Ann Liebert, Inc.To cite this article:Alexander M. Berry, Fernando Korkes, Marcos Ferreira, and Jim C. Hu.Robotic Urethrovesical Anastomosis: Combining Running and Interrupted Sutures.Journal of Endourology.Sep 2008.2127-2130.http://doi.org/10.1089/end.2008.0099Published in Volume: 22 Issue 9: September 23, 2008PDF download

Residual benign prostatic glands at the urethrovesical anastomosis after radical retropubic prostatectomy: prediction and impact on disease outcome.

Objective: To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values. Methods: High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software; then, the reconstructed 3D image was imported into VR development engine for VR research; afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC; therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared; the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively. Results: 3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ; according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2 cases of type Ⅱa,9 cases of type Ⅱb and 1 case of type Ⅱc. All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology. There were 15 cases whose assessment results based on preoperative CT/MRI were consistent with intraoperative findings, with a coincidence rate of 75.0%(15/20); while in VR environment, the assessment results of 3D visualization with blood vessel as axis were all consistent with the intraoperative findings, with coincidence rate of 100%(20/20). There was a statistically significant difference between the groups (χ(2)=5.714, P=0.017). There was no red blood cell transfusion in all patients during the operation. The preoperative hemoglobin was (128.8±14.9)g/L, and it was (119.8±12.5)g/L on postoperative day 1. There was no significant difference between these two sets of data (t=2.07, P=0.054). No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred. Conclusion: Preoperative evaluation based on 3D visualization and VR technology with blood vessel as the axis has significant clinical value for preoperative planning and surgical navigation of centrally located HCC.

LAPAROSCOPIC RADICAL PROSTATECTOMY WITH THE HEILBRONN TECHNIQUE: AN ANALYSIS OF THE FIRST 180 CASES

Salvage radiotherapy in patients with persisting/rising PSA after radical prostatectomy for prostate cancer

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Urinary function after radical prostatectomy: a comparison of the retropubic and perineal approaches

Easy Visualization of the Membranous Urethral Stump in Radical Prostatectomy

Vesicourethral healing following radical prostatectomy: Is it related to surgical approach?

Urinary leakage at the urethrovesical anastomosis is a rare but troublesome complication after radical prostatectomy. Usually, the anastomosis is almost watertight when tested during the operation and small leakages typically seal off in a few days. We describe 3 cases with postoperative urinary leakage where we have utilized a simple procedure of replacing the standard Foley catheter with another catheter with extra side fenestrations close to the anastomosis. Side fenestrations provide efficient drainage at the anastomosis area leading to a rapid resolution of the leakage. The method described represents an effective and low-risk solution to a potentially harmful complication.

In recent years, crowd-sourced assessments have been reported as a timesaving, cost-efficient, and practicable method of surgical skill evaluation. However, the differences in the assessment of surgical skills by the individual reviewers cannot be further examined in terms of characteristics of the reviewers because they are usually anonymously and randomly selected. This study aimed to reveal the effects of reviewers' occupations on their assessment of a surgeon's skill. In total, 42 urologists, 19 paramedics, 73 medical students, and 28 non-medical personnel used the Global Evaluative Assessment of Robotic Skills (GEARS) validated robotic surgery rating tool to assess the surgical skill of surgeons in nine edited video clips of complete urethrovesical anastomosis during a robot-assisted radical prostatectomy. The total GEARS scores of the four groups of reviewers were compared, and the similarities and the differences between the ratings of the urologists group and those of the other three groups were subsequently investigated. The rankings of video clips in the order of GEARS scores were very similar in each group, and a strong positive correlation (R2 values >0.8) was observed between the scores assigned by the urologists group and those assigned by the other three groups. Our findings indicate that the crude evaluation of robot-assisted urethrovesical anastomosis is not affected by the reviewers' occupations. Non-medical personnel may be able to provide a rudimentary screening evaluation of surgical skill.

To incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into three-dimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. The expert group achieved faster task-specific times for nerve-sparing (P = 0.007) and superior surgical margin results (P = 0.011). Nerve forces applied were significantly lower for the expert group with regard to maximum force (P = 0.011), average force (P = 0.011), peak frequency (P = 0.027) and total energy (P = 0.003). Higher force sensitivity (subcategory of GEARS score) and total GEARS score correlated with lower nerve forces (total energy in Joules) applied to NVB during the simulation with a correlation coefficient (r value) of -0.66 (P = 0.019) and -0.87 (P = 0.000), respectively. Both total and force sensitivity GEARS scores were significantly higher in the expert group compared to the novice group (P = 0.003). UVA leak rate highly correlated with total RACE score r value = -0.86 (P = 0.000). Mean RACE scores were also significantly different between novices and experts (P = 0.003). We present a realistic, feedback-driven, full-immersion simulation platform for the development and evaluation of surgical skills pertinent to NS-RARP. The correlation of validated objective metrics (GEARS and RACE) with our CRPMS suggests their application as a novel method for real-time assessment and feedback during robotic surgery training. Further work is required to assess the ability to predict live surgical outcomes.

BackgroundPositive surgical margin (PSM) or apical positive surgical margin (APSM) is an established predictive factor of biochemical recurrence or disease progression in prostate cancer (PCa) patients after radical prostatectomy. Since there are limited usable magnetic resonance imaging (MRI)-based models, we sought to explore the role of three-dimensional (3D) visualization for preoperative MRI in the prediction of PSM or APSM.MethodsFrom December 2016 to April 2022, 149 consecutive PCa patients who underwent radical prostatectomy were retrospectively selected from the Second Affiliated Hospital of Dalian Medical University. According to the presence of PSM or APSM, patients were divided into a PSM group (n=41) and a without PSM group (n=108) and into an APSM group (n=33) and a without APSM group (n=116). Twenty-one parameters, including prostate apical shape, PCa distance to the membranous urethra, and pubic angle, were measured on 3D visualization of MRI. The development of the nomogram models was built by the findings of multivariate logistic regression analysis for significant factors.ResultsTo predict the probability of PSM, a longer PCa distance to the membranous urethra (OR=0.136, p=0.019) and the distance from the anterior peritoneum to the anterior border of the coccyx (work space AP, OR=0.240, p=0.030) were independent protective factors, while a type 3 prostate apical shape (OR=8.262, p=0.025) and larger pubic angle 2 (OR=5.303, p=0.029) were identified as independent risk factors. The nomogram model presented an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of PSM of 0.777. In evaluating the incidence of APSM, we found that the distance to the membranous urethra (OR=0.135, p=0.014) was associated with a low risk of APSM, while larger pubic angle 1 (OR=4.666, p=0.043) was connected to a higher risk of APSM. The nomogram model showed that the AUC of APSM was 0.755.ConclusionAs 3D visualization for preoperative MRI showed good performance in predicting PSM or APSM, the tool might be potentially valuable, which also needs to be validated by multicenter, large-scale, prospective studies.

A SYSTEMATIC REVIEW AND CRITIQUE OF THE LITERATURE RELATING HOSPITAL OR SURGEON VOLUME TO HEALTH OUTCOMES FOR 3 UROLOGICAL CANCER PROCEDURES

Robotic surgery bedside assistants play an important role in robotic procedures by performing intra-corporeal tasks while accommodating the physical presence of the robot. We hypothesized that an augmented reality headset enabling 3D intra-corporeal vision while facing the surgical field could decrease time and improve accuracy of robotic bedside tasks. Bedside assistants (one physician assistant, one medical student, three surgical trainees, and two attending surgeons) performed validated tasks within a mock abdominal cavity with a surgical robot docked. Tasks were performed with a bedside monitor providing 2D or 3D vision, or an optical see-through head-mounted augmented reality device with 2D or 3D vision. The effect of augmented reality device resolution on performance was also evaluated. For the simplest task of touching a straw, performance was generally high, regardless of mode of visualization. With more complex tasks, including stapling and pulling a ring along a path, 3D augmented reality decreased time and number of errors per task. 3D augmented reality allowed the physician assistant to perform at the level of an attending surgeon using 3D augmented reality (p = 0.08). All participants had improved times for the ring path task with better resolution (lower resolution 23 ± 11s vs higher resolution 14 ± 4s, p = 0.002). 3D augmented reality vision with high resolution decreased time and improved accuracy of more complex tasks, enabling a less experienced robotic surgical bedside assistant to function similar to attending surgeons. These data warrant further study with additional complex tasks and bedside assistants at various levels of training.