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.

Laparoscopic radical prostatectomy: reducing the learning curve.

Resumen Objetivos Describir el inicio de un programa de laparoendoscopia a traves de puerto unico para llevar a cabo la cirugia oncologica de un Servicio de Urologia. Presentamos la experiencia inicial en laboratorio y en animalario con instrumentos precurvados rigidos y elemento de acceso reutilizable tipo KeyPort (Richard Wolf). Material y metodos Dos cirujanos experimentados en cirugia laparoscopica, con la ayuda de 4 ayudantes, llevaron a cabo un programa de entrenamiento mediante tareas predeterminadas en caja de simulacion y en modelo suido, siguiendo los requisitos de la Comunidad Autonoma de Madrid para el manejo de animales de experimentacion. Resultados Los participantes en este programa inicialmente se dividieron en parejas compuestas por cirujano experimentado y ayudante para la realizacion de multiples tareas predeterminadas en la caja de simulacion, con intencion de familiarizarse con los instrumentos. Seguidamente se llevaron a cabo 20 sesiones animales en las que se realizaron disecciones ganglionares (pelvica o retroperitoneal) (n = 20), nefrectomias (n = 40), cistorrafias con sutura (n = 20) y anastomosis uterino-vesicales (n = 20). Se registraron los tiempos necesarios para la realizacion de los ejercicios y los principales errores percibidos en la realizacion de cada una de las tareas. Las tareas de complejidad creciente fueron realizadas con el instrumental descrito cada vez en menor tiempo y con menos dificultad. Se preciso un trocar accesorio de 3,5 mm para la realizacion de las suturas in vivo. Conclusiones El abordaje KeyPort tiene aplicacion potencial en diferentes aplicaciones urologicas. Un entrenamiento reglado permite la adquisicion de destrezas y posibilita la implantacion con exito de un programa de cirugia laparoendoscopica en humanos.

Puesta en marcha de un programa de entrenamiento para laparoscopia urológica por puerto único

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.

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