Abstrakt Ostatní Březen 2011

“Impact of caseload on total hospital charges: A direct comparison between minimally invasive and open radical prostatectomya population based study.”

Abdollah, F., L. Budus, et al. (2011).

Journal of Urology 185(3): 855-861.


Purpose We tested the relationship between caseload and total hospital charges after stratifying by minimally invasive and open radical prostatectomy. Materials and Methods We evaluated 1,188 vs 3,354 men treated with minimally invasive vs open radical prostatectomy in the Florida Hospital Inpatients data file in 2008. Caseload was defined as the count of procedures performed by each surgeon between the study start on January 1, 2008 and the date of each procedure. Patients were divided into tertiles based on their procedure specific caseload. Univariate and multivariate analysis was done to address the relation between caseload and total hospital charges for the minimally invasive and open procedures. Covariates were patient age, race, comorbidity, and length of stay. Results Median total hospital charges for minimally invasive and open radical prostatectomy were $33,234 and $33,674, respectively (p = 0.03). Median total hospital charges in the low, intermediate and high minimally invasive vs open procedure caseload tertiles were $41,765, $34,799 and $28,780 vs $35,642, $34,726 and $32,726, respectively. On multivariate analysis with the high minimally invasive caseload tertile as the reference category the increments of the probability of charges in excess of the 2008 median of $33,588 were 3.9 and 8.1-fold for the intermediate and low caseload minimally invasive procedures, and 2.5, 3.6 and 2.8-fold for the high, intermediate and low caseload open procedures, respectively (each p <0.001). Conclusions Overall median total hospital charges are virtually the same for minimally invasive and open radical prostatectomy. However, total hospital charges for the minimally invasive procedure have a more sensitive caseload effect, as evidenced by the wider distribution of the median of minimally invasive caseload specific total hospital charges vs that of open radical prostatectomy. The high caseload minimally invasive procedure resulted in the lowest total hospital charges relative to all other minimally invasive and open radical prostatectomy categories. © 2011 American Urological Association Education and Research, Inc.




“Nintendo wii video-gaming ability predicts laparoscopic skill: Editorial comment.”

Cadeddu, J. A. (2011).

Journal of Urology 185(3): 939.




“Robotic surgery or master-slave device?”

Galata, G. and M. Hannan (2011).

Surgical Endoscopy 25(4): 1347-1348.




“How to dissect surgical journals: VIII – Comparing outcomes.”

Hall, J. C. (2011).

ANZ Journal of Surgery 81(3): 190-196.




“Intellectual innovation and new technology in surgical oncology.”

Hottenrott, C. (2010).

Gastric and Breast Cancer 9(3): 110-112.


The advent of new technologies has revolutionized biomedical research. But clinical implications for improving health are hard. This article discusses how these technological explosion including laparoscopic and robotic surgery and next-generation DNA sequencing technology influences surgical oncology practice. Moreover, it is discussed why these technological advances without scientific innovative thinking will have modest efficacy in changing poor outcomes of patients with advanced solid cancers.




“Surgery in the year 2025.”

Lamadé, W. and F. Rieber (2011).

Chirurgie im Jahre 2025 24(1): 12-19.


In order to predict the future of surgery, it should be considered that surgical progress has always been and will continue to be closely tied to technological progress and the general development of society. Furthered by demographic change, new therapeutic concepts and techniques will emerge between conflicting demands of patients, surgeons and economists. Procedures with further reduced surgical invasiveness will become standard treatment options in various surgical disciplines. The required expertise will disseminate extensively and simulator-based training of minimally-invasive operations will become a prerequisite for young surgeons in the future. The reduction of surgical trauma will be paralleled by the development of new diagnostic and therapeutic means of treatment in earlier stages of disease. The migration of patients to other medical specialties such as interventional gastroenterology will be partly compensated by the increasing number of patients with malignant diseases that will become eligible for surgery by means of early disease detection. Cooperations between surgeons and other physicians, e. g. for performing rendez-vous-interventions, will strengthen the establishment of multidisciplinary departments. Due to demographic change, a variety of surgical domains such as colorectal surgery will undergo significant decline while other areas like hernia surgery and tumor surgery will increase. Morbid obesity and obesity-related health problems are currently regarded as one of the most important future domains of surgery. The role of morbid obesity for the future of surgery might however be overrated since the development of an improved pathophysiological understanding of the underlying causes of the disease might lead to effective therapeutic strategies and render bariatric surgery obsolete. New treatment concepts might partially replace surgery in other indications as well. Thyroid surgery in Europe, for instance, is expected to suffer significant decline similar to the present situation in North America. The incidence of colon cancer will most likely increase in the future; however, conservative and interventional treatment will become more and more important. Despite the expected reduction in gastric cancer due to effective pharmacological treatment options, early disease detection and neoadjuvant chemotherapy will lead to increasing numbers of cases eligible for curative surgical treatment. Besides the persistence and increase of minor abdominal surgery, e. g. hernia repair and cholecystectomy, multivisceral surgery and debulking will become increasingly more important. Further, a new and highly specialized field of complex minimally-invasive surgery will emerge. New technologies and synergistic application of existing technologies that comprise specialized functionality as well as universal application and interoperation will ensure the long-term sustainability of surgery. Besides the benefit of improved minimal-invasive technology, the surgical armamentarium will be further enhanced by the integration of sensor data and diagnostic information. Combining pre- and intraoperative imaging and diagnostics in realtime will enable surgical operation planning and navigation. These technologies will in turn provide the basis for robotic support systems in the operating room. Robotic assistance will be substantial for the progression of surgical precision, effectiveness and safety. The enhancement of diagnostic modalities and improved ergonomics are currently considered to be the most important foundation for future developments. Simulator technology and innovative educational approaches will allow for focused surgical training and help in attracting young talented doctors to surgery. At present, it can be considered evident that the surgical profession will be further split into highly specialised domains with few generalists and a great number of super-specialits. © Georg Thieme Verlag KG Stuttgart New York.




“Long-term quality of life following primary treatment in men with clinical stage T3 prostate cancer.” Namiki, S., T. Tochigi, et al. (2011).

Quality of Life Research 20(1): 111-118.


Objectives: We evaluated the changes of health-related quality of life (HRQOL) during the 5 years after radical prostatectomy (RP) or external beam radiation therapy (EBRT) for clinical stage T3 prostate cancer (cT3PC). Patients and methods: A total of 750 patients who underwent RP (n = 575) or EBRT (n = 175) participated in our longitudinal outcomes study. Of these patients, 48 RP patients (8%) and 63 EBRT patients (36%) presented with cT3PC and were included in this analysis. Patients completed the general and disease-specific HRQOL with the Short Form 36 (SF-36) and University of California, Los Angeles Prostate Cancer Index, respectively. Results: When examining the mean SF-36 values by time, there was significant impact on treatment outcomes for several items of the general HRQOL in the RP subjects. Those who underwent EBRT reported no significant changes in the general HRQOL throughout the follow-up period. With regard to disease-specific HRQOL, the RP subjects had significantly worse urinary HRQOL post-operatively than the EBRT subjects (P < 0.001). The scores for sexual function declined over the 60 months, but more so in the RP group. The two groups showed similar bowel HRQOL scores throughout the follow-up periods. Conclusions: Both primary treatments for cT3PC can offer satisfactory functional outcomes from the HRQOL perspective, except for a persistent decrease in the sexual activity score. These results may guide the treatment selection and clinical management of patients with HRQOL impairments after treatment for cT3PC. © 2010 Springer Science+Business Media B.V.




“Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate Cancer.”

Nguyen, P. L., X. Gu, et al. (2011).

Journal of Clinical Oncology.


PURPOSE Intensity-modulated radiation therapy (IMRT) and laparoscopic or robotic minimally invasive radical prostatectomy (MIRP) are costlier alternatives to three-dimensional conformal radiation therapy (3D-CRT) and open radical prostatectomy for treating prostate cancer. We assessed temporal trends in their utilization and their impact on national health care spending. METHODS Using Surveillance, Epidemiology, and End Results-Medicare linked data, we determined treatment patterns for 45,636 men age >/= 65 years who received definitive surgery or radiation for localized prostate cancer diagnosed from 2002 to 2005. Costs attributable to prostate cancer care were the difference in Medicare payments in the year after versus the year before diagnosis. Results Patients received surgery (26%), external RT (38%), or brachytherapy with or without RT (36%). Among surgical patients, MIRP utilization increased substantially (1.5% among 2002 diagnoses v 28.7% among 2005 diagnoses, P < .001). For RT, IMRT utilization increased substantially (28.7% v 81.7%; P < .001) and for men receiving brachytherapy, supplemental IMRT increased significantly (8.5% v 31.1%; P < .001). The mean incremental cost of IMRT versus 3D-CRT was $10,986 (in 2008 dollars); of brachytherapy plus IMRT versus brachytherapy plus 3D-CRT was $10,789; of MIRP versus open RP was $293. Extrapolating these figures to the total US population results in excess spending of $282 million for IMRT, $59 million for brachytherapy plus IMRT, and $4 million for MIRP, compared to less costly alternatives for men diagnosed in 2005. CONCLUSION Costlier prostate cancer therapies were rapidly and widely adopted, resulting in additional national spending of more than $350 million among men diagnosed in 2005 and suggesting the need for comparative effectiveness research to weigh their costs against their benefits.




“Temporal relationship between positive margin rate after laparoscopic radical prostatectomy and surgical training.”

Page, J. B., D. L. Davenport, et al. (2011).

Urology 77(3): 626-630.


Objectives To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify. Methods A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated. The potential impact of the experience of the first assistant on the PSMR was evaluated by examining the relationship between the PSMR and the time of the academic year. Multivariable logistic regression analysis was used to adjust for patient age, Gleason’s sum, tumor density, and pathologic stage. Results Overall positive margin rate was 18.2%. Positive margin rate for July and August (14/45, 31.1%) was significantly higher than for the remaining 10 months (41/258, 15.9%) P = .015. The increased risk of positive margin in July/August remained significant after adjusting for age, Gleason’s sum, tumor density, and pathologic stage (OR 2.65, 95% CI 1.215.79, P = .015) Conclusions LRP performed with the first assistant in the first 2 months of the academic training year have a significantly higher PSMR. © 2011 Elsevier Inc.




“What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?”

Vickers, A. and J. Eastham (2011).

Urologic Oncology: Seminars and Original Investigations 29(2): 118-123.




“Documenting the Genie’s Escape: Robotic Surgery.”

Barry, M. (2011).

Medical Care 49(4): 340-342.




“Telerobotic anterior translocation of the ulnar nerve.”

Garcia Jr, J. C., G. Mantovani, et al. (2011).

Journal of Robotic Surgery: 1-4.


The application of telerobotics in the biomedical field has grown rapidly and is showing very promising results. Robotically assisted microsurgery and nerve manipulation are some of its latest innovations. The purpose of this article is to update the community of shoulder and elbow surgeons on that field. Simple anterior subcutaneous translocation of the ulnar nerve was first experimented in two cadavers, and then performed in one live patient who presented with cubital tunnel syndrome. This procedure is the first reported case using the robot in elbow surgery. In this paper we attempt to analyze various aspects related to human versus robotically assisted surgery. © 2011 Springer-Verlag London Ltd.




“… Minimally invasive surgery. Robotic technology speeds recovery and improves outcomes.”

Godfrey, A. (2010).

JAAPA : official journal of the American Academy of Physician Assistants 23(10): 53-54.




“How Do We Improve Techniques in Robotic Surgery?”

Guru, K. and M. Menon (2011).

Journal of Urology.




“Surgery in space: the future of robotic telesurgery.”

Haidegger, T., J. Sandor, et al. (2011).

Surgical Endoscopy 25(3): 681-690.


BACKGROUND: The origins of telemedicine date back to the early 1970s, and combined with the concept of minimally invasive surgery, the idea of surgical robotics was born in the late 1980s based on the principle of providing active telepresence to surgeons. Many research projects were initiated, creating a set of instruments for endoscopic telesurgery, while visionary surgeons built networks for telesurgical patient care, demonstrated transcontinental surgery, and performed procedures in weightlessness. Long-distance telesurgery became the testbed for new medical support concepts of space missions. METHODS: This article provides a complete review of the milestone experiments in the field, and describes a feasible concept to extend telemedicine beyond Earth orbit. With a possible foundation of an extraplanetary human outpost either on the Moon or on Mars, space agencies are carefully looking for effective and affordable solutions for life-support and medical care. The major challenges of surgery in weightlessness are also discussed. RESULTS: Teleoperated surgical robots have the potential to shape the future of extreme health care both in space and on Earth. Besides the apparent advantages, there are some serious challenges, primarily the difficulty of latency with teleoperation over long distances. Advanced virtualization and augmented-reality techniques should help human operators to adapt better to the special conditions. To meet safety standards and requirements in space, a three-layered architecture is recommended to provide the highest quality of telepresence technically achievable for provisional exploration missions. CONCLUSION: Surgical robotic technology is an emerging interdisciplinary field, with a great potential impact on many areas of health care, including telemedicine. With the proposed three-layered concept-relying only on currently available technology-effective support of long-distance telesurgery and human space missions are both feasible.




“The Association Between Diffusion of the Surgical Robot and Radical Prostatectomy Rates.”

Makarov, D. V., J. B. Yu, et al. (2011).

Medical Care 49(4): 333-339.


BACKGROUND: Despite its expense and controversy surrounding its benefit, the surgical robot has been widely adopted for the treatment of prostate cancer. OBJECTIVES: To determine the relationship between surgical robot acquisition and changes in volume of radical prostatectomy (RP) at the regional and hospital levels. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Men undergoing RP for prostate cancer at nonfederal, community hospitals located in the states of Arizona, Florida, Maryland, North Carolina, New York, New Jersey, and Washington. MEASURES: Change in number of RPs at the regional and hospital levels before (2001) and after (2005) dissemination of the surgical robot. RESULTS: Combining data from the Healthcare Cost and Utilization Project State Inpatient Databases 2001 and 2005 with the 2005 American Hospital Association Survey and publicly available data on robot acquisition, we identified 554 hospitals in 71 hospital referral regions (HRR). The total RPs decreased from 14,801 to 14,420 during the study period. Thirty six (51%) HRRs had at least 1 hospital with a surgical robot by 2005; 67 (12%) hospitals acquired at least 1 surgical robot. Adjusted, clustered generalized estimating equations analysis demonstrated that HRRs with greater numbers ofhospitals acquiring robots had higher increases in RPs than HRRsacquiring none (mean changes in RPs for HRRs with 9, 4, 3, 2, 1, and 0 are 414.9, 189.6, 106.6, 14.7, -11.3, and -41.2; P<0.0001). Hospitals acquiring surgical robots increased RPs by amean of 29.1 per year, while those without robots experienced a mean change of -4.8, P<0.0001. CONCLUSIONS: Surgical robot acquisition is associated with increased numbers of RPs at the regional and hospital levels. Policy makers must recognize the intimate association between technology diffusion and procedure utilization when approving costly new medical devices with unproven benefit.




“Imaging in gynecologic surgery.”

Mettler, L., W. Sammur, et al. (2011).

Womens Health (Lond Engl) 7(2): 239-250.


The technical development of instruments for endoscopic surgery started in the field of gynecology. In the early 1970s, with the improvement of optics and instruments for laparoscopic surgery, gyne-endoscopic surgery developed and set milestones for all other surgical fields. However, the general surgeons propagated the advantages of 2D or 3D imaging surgery much better than the conservative gynecologists. Surgery on a 2D screen without direct vision is regarded as more advantageous than open surgery and has achieved wide acceptance. Several schools of gynecologic endoscopy in Europe (in Kiel, Giessen, Clermont Ferrand and Strasbourg) have set guidelines for gyne-endoscopic surgery. Our catalog of indications in the areas of gyne-endoscopic surgery, published in 2002, reveals the broad application of these techniques today. 3D vision, robotic instruments and systems, such as the da Vinci((R)) Surgical System from Intuitive Surgical, Inc. (CA, USA), round up the picture of endoscopic surgery. The advantages of endoscopic surgery over open surgery (more precision, less trauma, less postoperative pain, shorter hospital stays and a faster recovery period) are becoming more accepted. The present healthcare systems and hospital administrations understand the challenges of imaging in surgery, particularly in endoscopic surgery.




“Purposeful design in surgical robotics.”

Nelson, C. A. and D. Oleynikov (2011).

Surgical Endoscopy 25(4): 1349-1350.




“Impact quantification of the daVinci telemanipulator system on surgical workflow using resource impact profiles.”

Neumuth, T., A. Krauss, et al. (2011).

Int J Med Robot.


BACKGROUND: It has yet to be determined whether surgical assist systems benefit surgical workflow. This question should be answered qualitatively and quantitatively and must be supported by evidence gathered from structured and rigorous analyses. METHODS: A method is presented to quantify the benefits of the daVinci telemanipulator system to surgical workflow. Based on the modeling of surgical processes, resource impact profiles (RIPs) were generated. RIPs are statistical mean intervention courses for a sample of surgical process models that were performed using a specific surgical assist system as a resource. A total of 12 laparoscopic and 12 telemanipulator-supported Nissen fundoplications were modeled and analyzed to quantify the impact of the surgical assist system. RESULTS: Few statistically significant benefits of the system to surgical workflow were found. It was found that the daVinci system is not superior to the conventional laparoscopic strategy if the surgeon follows the same workflow. CONCLUSIONS: RIPs are a valuable method to estimate the impact of a surgical assist system on the surgical workflow. For the use case investigated, changes in workflow may be necessary to fully benefit from the advantages of using a telemanipulator in Nissen fundoplications. Conversely, the telemanipulator may only reach its full potential in more complex operations. Copyright (c) 2011 John Wiley & Sons, Ltd.




“Meet Dr. Robot. Your next surgeon may not be human. Why that should make you happy–and a little wary.”

Von Drehle, D. (2010).

Time 176(24): 44-49.




“To Infinity and Beyond: The Robotic Toy Story.”

Yates, D. R., M. Roupret, et al. (2011).

European Urology.



“[Current potential of robot-assisted vascular surgery].”

Stádler, P., L. Dvorácek, et al. (2010).

Soucasné moznosti roboticky asistované cévní chirurgie. 89(1): 28-32.


Based on experience with 150 robot-assisted vascular reconstructions, the authors discuss current potential applications of the Da Vinci robotic system in vascular surgery, as well as a potential for further use of this new technology in vascular surgery. In vascular surgery, laparoscopic methods have never been used as much as in general surgery. Although many studies presenting interesting outcomes have been published, laparoscopic vascular surgery has not been generally accepted. Its main problems include duration of the procedure and, in particular, the vascular staple size and associated difficulties with the vascular anastomosis suturing. However, recently, there have been many revolutionary advancements in medicine, including vascular surgery. Robot-assisted surgery is the next step in the development of miniinvasive methods. From November 2005 to August 2009, the authors performed 150 robot-assisted vascular reconstructions in the aorto-iliac region. Besides aorto-femoral reconstructions, the most significant procedures also included aortic aneurysm procedures, procedures on pelvic and splenic arteries, as well as hybrid procedures. In four cases (2.7%) conversion to classical procedures were required and four subjects (2.7%) developed serious postoperative complications. In a single case (0.7%), the robotic apparatus had a defect during the procedure and the procedure was completed using laparoscopy. In a single case (0.7%), the procedure had to be cancelled because of an inoperable finding on the aorta. The average duration of the procedure in this study group was 228 minutes, the average time required for anastomosis suturing was 27 minutes and the average stapling time was 39 minutes. Robotic systems increase accuracy, control and quality of surgical procedures and offer higher quality surgery to patients. The authors managed to reach the world primacy in the field of vascular surgery and the Czech Republic has become a significant world leader in this superspecialized surgical specialty.




“Robotic technology in spine surgery: current applications and future developments.”

Stüer, C., F. Ringel, et al. (2011).

Acta neurochirurgica. Supplement 109: 241-245.


Medical robotics incrementally appears compelling in nowadays surgical work. The research regarding an ideal interaction between physician and computer assistance has reached a first summit with the implementation of commercially available robots (Intuitive Surgical’s® da Vinci®). Moreover, neurosurgery–and herein spine surgery–seems an ideal candidate for computer assisted surgery. After the adoption of pure navigational support from brain surgery to spine surgery a meanwhile commercially available miniature robot (Mazor Surgical Technologies’ The Spine Assist®) assists in drilling thoracic and lumbar pedicle screws. Pilot studies on efficacy, implementation into neurosurgical operating room work flow proved the accuracy of the system and we shortly outline them. Current applications are promising, and future possible developments seem far beyond imagination. But still, medical robotics is in its infancy. Many of its advantages and disadvantages must be delicately sorted out as the patients safety is of highest priority. Medical robots may achieve a physician’s supplement but not substitute.


“Framework for incorporating simulation into urology training.”

Arora, S., B. Lamb, et al. (2011).

BJU International 107(5): 806-810.


Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Simulation-based training can provide urology trainees with the opportunity to develop their technical and non-technical skills in a safe and structured environment. Despite its promised benefits, incorporation of simulation into current curricula remains minimal. This paper provides a comprehensive review of the current status of simulation for both technical and non-technical skills training as it pertains to urology. It provides a novel framework with contextualised examples of how simulation could be incorporated into a stage-specific curriculum for trainees through to experienced urologists, thus aiding its integration into current training programmes. OBJECTIVES Changes to working hours, new technologies and increased accountability have rendered the need for alternative training environments for urologists. Simulation offers a promising arena for learning to take place in a safe, realistic setting. Despite its benefits, the incorporation of simulation into urological training programmes remains minimal. The current status and future directions of simulation for training in technical and non-technical skills are reviewed as they pertain to urology. A framework is presented for how simulation-based training could be incorporated into the entire urological curriculum. MATERIALS AND METHODS The literature on simulation in technical and non-technical skills training is reviewed, with a specific focus upon urology. RESULTS To fully integrate simulation into a training curriculum, its possibilities for addressing all the competencies required by a urologist must be realized. At an early stage of training, simulation has been used to develop basic technical skills and cognitive skills, such as decision-making and communication. At an intermediate stage, the studies focus upon more advanced technical skills learnt with virtual reality simulators. Non-technical skills training would include leadership and could be delivered with in situ models. At the final stage, experienced trainees can practise technical and non-technical skills in full crisis simulations situated within a fully-simulated operating rooms. CONCLUSIONS Simulation can provide training in the technical and non-technical skills required to be a competent urologist. The framework presented may guide how best to incorporate simulation into training curricula. Future work should determine whether acquired skills transfer to clinical practice and improve patient care. © 2010 BJU International.




“Training surgical skills using nonsurgical tasks-can nintendo WiiTM improve surgical performance?” Boyle, E., A. M. Kennedy, et al. (2011).

Journal of Surgical Education 68(2): 148-154.


Background It has been suggested that abilities in nonsurgical tasks may translate to the surgical setting, with video gaming attracting particular attention because of the obvious similarities in the skills required. The aim of this study was to assign laparoscopic novices prospectively to receive a period of structured practice on the Nintendo WiiTM (Nintendo of America, Inc, Redmond, Washington) and compare their performance of basic laparoscopic tasks before and after this session to control subjects. Methods In all, 22 medical students with no prior laparoscopic or video game experience were recruited to the study. They were randomized into 2 groups: group 1 served as the control and group 2 was the WiiTM group. All subjects performed 2 physical (bead transfer and glove cutting) and 1 virtual laparoscopic simulated tasks on the ProMIS surgical simulator (Haptica, Boston, Massachusetts). Performance metrics were measured. The same tasks were repeated an average of 7 days later, and between the 2 sessions, the subjects in the WiiTM group had structured practice sessions on the WiiTM video game. Results Taken together, all subjects improved their performance significantly from session 1 to session 2. For the physical tasks, the WiiTM group performed better on session 2 for all metrics but not significantly. The WiiTM group showed a significant performance improvement for one metric in the bead transfer task compared with controls. For the virtual task, there was no significant improvement between sessions 1 and 2. Conclusions The novice subjects demonstrated a steep learning curve between their first and second attempts at the laparoscopic tasks. Practicing on the WiiTM was associated with a trend toward a better performance on session 2, although the difference was not significant. This finding suggests that a more intensive practice schedule may be associated with a better performance, and we propose that training on non-surgical tasks may be a cheap, convenient, and effective addition to current training curricula. © 2011 Association of Program Directors in Surgery.




“Comparison of Teenaged Video Gamers vs PGY-I Residents in Obstetrics and Gynecology on a Laparoscopic Simulator.”

Fanning, J., B. Fenton, et al. (2011).

Journal of Minimally Invasive Gynecology 18(2): 169-172.


Study Objective: To compare the performance of teenaged video gamers verses postgraduate year I (PGY-I) residents in obstetrics and gynecology (Ob/Gyn) on our video trainer laparoscopic simulator. Design: Randomized controlled trial (Canadian Task Force Classification I). Setting: Medical school university. Participants: Teenaged video gamers and PGYI Ob/Gyn Residents. Intervention: Laparoscopic simulator. Measurements and Main Results: Fifteen teenaged experienced video gamers and 15 PGYI Ob/Gyn residents without video gaming experience were timed performing 3 laparoscopic simulator assessment procedures. Each drill was timed using a stopwatch. Pretest instructions were given as to how to perform each task. No warm-up was allowed, and each participant was tested during his or her initial performance of each assessment drill. Compared with the PGYI Ob/Gyn residents, the teenaged experienced video gamers completed the Bean and Pom-Pom Drop 27% faster (p = .05), the Checkerboard Drill 41% faster (p = .03), and the Bead Manipulation 31% faster (p = .43). Conclusion: Virtual reality skills of teenaged video gamers seem to translate into improved video trainer laparoscopic skills. Previous teenage video gaming experience may favorably affect future residents’ ability to develop laparoscopic skills. © 2011 AAGL.




“Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot).”

Gavazzi, A., A. N. Bahsoun, et al. (2011).

Annals of the Royal College of Surgeons of England 93(2): 152-156.


INTRODUCTION:This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool. SUBJECTS AND METHODS: The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon’s knot. Thirty participants (18 novices, 12 experts) completed the procedures. RESULTS: The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon’s knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants. CONCLUSIONS: The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.




“ProMISTM can serve as a da Vinci® simulator – A construct validity study.”

Jonsson, M. N., M. Mahmood, et al. (2011).

Journal of Endourology 25(2): 345-350.


Purpose: The purpose of this study was to investigate if the ProMISTM simulator could serve as a training platform for the da Vinci® surgical system and if this constellation could prove construct validity. Materials and Methods: The da Vinci system was connected to the ProMIS simulator, which registered objective data concerning how the surgeon performed in the box environment related to time, path, and smoothness. Five experienced robotic surgeons passed four different surgical tasks with progressive difficulty. A novice group – constituted of 13 consultants and 6 residents, none of them with any previous experience in the da Vinci system – passed the same tasks and the data were compared with the results from the expert group. Results: A statistically significant difference between experts and novices was demonstrated in all tasks concerning time and smoothness. For the parameter path, significant difference was only noted in the more complex tasks. Conclusions: Our study showed that ProMis could differentiate between experienced robotic surgeons and novices, thereby proving construct validity. Smoothness appeared to be the most sensitive objective parameter in our study. Tasks with high complexity are recommended when designing the program for robotic training. Copyright 2011, Mary Ann Liebert, Inc.




“Best Practices for Robotic Surgery Training and Credentialing.”

Lee, J. Y., P. Mucksavage, et al. (2011).

Journal of Urology.


Purpose: With the rapid and widespread adoption of robotics in surgery, the minimally invasive surgical landscape has changed markedly within the last half decade. This change has had a significant impact on patients, surgeons and surgical trainees. This is no more apparent than in the field of urology. As with the advent of any new surgical technology, it is imperative that we develop comprehensive and responsible training and credentialing initiatives to ensure surgical outcomes and patient safety are not compromised during the learning process. Materials and Methods: A literature search was conducted on surgical training curricula as well as robotic surgery training and credentialing to provide best practice recommendations for the development of a robotic surgery training curriculum and credentialing process. Results: For trainees to attain the requisite knowledge and skills to provide safe and effective patient care, surgical training in robotics should involve a structured, competency based curriculum that allows the trainee to progress in a graduated fashion. This structured curriculum should involve preclinical and clinical components to facilitate the proper adoption and application of this new technology. Robotic surgery credentialing should involve an expert determined, standardized educational process, including a minimum criterion of proficiency. Conclusions: Rather than being based on a set number of completed cases, robotic surgery credentialing should involve the demonstration of proficiency and safety in executing basic robotic skills and procedural tasks. In addition, the accreditation process should be iterative to ensure accountability to the patient. © 2011 American Urological Association Education and Research, Inc.




“Initial validation of the ProMIS surgical simulator as an objective measure of robotic task performance.”

McDonough, P. S., T. J. Tausch, et al. (2011).

Journal of Robotic Surgery: 1-5.


Virtual reality robotic simulation has gained widespread momentum. In order to determine the value of virtual reality robotic simulation and its objective metrics, a reality-based robotic surgical training platform with similar analytic capabilities must be developed and validated. The ProMIS laparoscopic surgical simulator is a widely available reality-based simulation platform that has been previously validated as an objective measure of laparoscopic task performance. In this study, we evaluated the validity of the ProMIS laparoscopic surgical simulator as an objective measure of robotic task performance. Volunteers were recruited from two experience groups (novice and expert). All subjects completed three tasks (peg transfer, precision cutting, intracorporeal suture/knot) in the ProMIS laparoscopic simulator using the da Vinci robotic surgical system. Motion analysis data was obtained by the ProMIS computerized optical tracking system and objective metrics recorded included time, path length, economy of motion, and observer-recorded penalty scores. The novice group consisted of 10 subjects with no previous robotic surgical experience. The expert group consisted of 10 subjects with robotic experience. The expert group outperformed the novice group in all three tasks. Subjects rated this training platform as easy to use, as an accurate measure of their robotic surgical proficiency, and as relevant to robotic surgery. The experts described the simulator platform as useful for training and agreed with incorporating it into a residency curriculum. This study demonstrates that the ProMIS laparoscopic simulator is a face, content, and construct valid reality-based simulation platform that can be used for objectively measuring robotic task performance. © 2011 Springer-Verlag London Ltd.




“Robotic technologies in surgical oncology training and practice.”

Orvieto, M. A., P. Marchetti, et al. (2010).

Surgical Oncology.


The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons whishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties. © 2010 Elsevier Ltd. All rights reserved.




“Content validation of a novel robotic surgical simulator.”

Seixas-Mikelus, S. A., A. P. Stegemann, et al. (2011).

BJU International 107(7): 1130-1135.


Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE: * To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System. PATIENTS AND METHODS: * Participants attending the 2010 International Robotic Urology Symposium were invited to experience RoSS. Afterwards, participants completed a survey regarding the appropriateness of the simulator as a teaching tool. RESULTS: * Forty-two subjects including surgeons experienced with robotics (n= 31) and novices (n= 11) participated in this study. * Eighty per cent of the entire cohort had an average of 4 years of experience with robot-assisted surgery. * Eleven (26%) novices lacked independent robot-assisted experience. The expert group comprised 17 (41%) surgeons averaging 881 (160-2200) robot-assisted cases. Experts rated the ‘clutch control’ virtual simulation task as a good (71%) or excellent (29%) teaching tool. * Seventy-eight per cent rated the ‘ball place’ task as good or excellent but 22% rated it as poor. * Twenty-seven per cent rated the ‘needle removal’ task as an excellent teaching tool, 60% rated it good and 13% rated it poor. * Ninety-one per cent rated the ‘fourth arm tissue removal’ task as good or excellent. * Ninety-four per cent responded that RoSS would be useful for training purposes. * Eighty-eight per cent felt that RoSS would be an appropriate training and testing format before operating room experience for residents. * Seventy-nine per cent indicated that RoSS could be used for privileging or certifying in robotic surgery. CONCLUSION: * Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity.