Da Vinci-Assisted Robotic Partial Nephrectomy: Technique and Results at a Mean of 15 Months of Follow-Up

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.14187

Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis.

Background and Purpose: Several training models have been developed to improve surgeons' operative skills as well as patient outcomes. Before implementing these models in training programs, their usefulness and accuracy need to be assessed. In this study, we examined the ability of a laparoscopic nephrectomy (LN) virtual reality (VR) simulator to distinguish between different levels of expertise (construct validity). Methods: Twenty-two novices (no LN experience), 32 intermediates (<10 LN procedures performed) and 10 experienced urologists (≥10 LN procedures performed) performed the same retroperitoneal task on the LN VR simulator (Mentice,® Sweden) three times, performing a practice task before and after the second time. Outcome parameters were time, blood loss, path length, and total score (combination of 62 different parameters). Results: No significant differences were found between intermediate and experienced participants. Task 3 performance showed no significant difference between any of t...

Virtual reality laparoscopic nephrectomy simulator is lacking in construct validity.

Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy.

/pdf/laparoscopic-nephroureterectomy-the-distal-ureteral-dilemma-9coia03oj9.pdf

Laparoscopic nephroureterectomy: the distal ureteral dilemma.

Laparoscopic radical prostatectomy: reducing the learning curve.

Objective: There has been a dramatic increase in the interest and practice of laparoscopic urology, with nephrectomy having become the commonest laparoscopic urological procedure. Compared with open nephrectomy, it results in reduced morbidity and shorter convalescence times while maintaining oncological safety. However, while these results predominately stem from institutions with well developed laparoscopic programmes, little is known about the results in centres that have newly adopted this technique. The introduction of a laparoscopic urological service at the Royal Hallamshire Hospital provided an opportunity to study these factors. Methods: Since the appointment in October 2000 of a urological surgeon (N Oakley) to develop the laparoscopic service, there have been over 200 laparoscopic procedures including 121 nephrectomies performed at this centre. Full details were collected for each of these cases, and in addition, compared with retrospective data for 50 open nephrectomies performed during the same time period. Results: With increased operator experience the median operative duration, complication, transfusion, and conversion rates significantly improved. While a learning curve was evident, the overall operative complication (9%) and conversion rates (6%) were low, in addition to patient morbidity (16.5%) and mortality (0%) rates, showing that this learning curve had no deleterious effects upon patient care. The median hospital stay was four days, which reduced to three with experience and was significantly shorter than for open nephrectomy at this institution (p = 0.001). Conclusions: The development of a successful laparoscopic programme can be achieved with a comparatively short learning curve and without detriment to the patient provided the necessary steps are observed.

https://pmj.bmj.com/content/postgradmedj/81/959/599.full.pdf

The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice.

Laparoscopic nephroureterectomy for upper tract urothelial cancer: a novel closed system pluck

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The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice.

Laparoscopic nephroureterectomy for upper tract urothelial cancer: a novel closed system pluck