The evolving role of simulators and training in robotic urological surgery: Which assessment tool to use?

Abstract

s / International Journal of Surgery 10 (2012) S53–S109 S101 ABSTRACTS injection. One patient with obstructed megaureter was converted to open technique because of limited working space and relatively large instruments. Mean total operating time was 225 minutes (range: 152-257) and console time 113minutes (range: 80-150). All discharged on post operative day 1. The catheter and stent were removed on day 7. There were no complications. Ultrasound scan and follow up in 1 and 4 months. This early experience support the view that robotic assisted intravesical reimplanation is feasible and safe. The ergonomic of tissue handling and suturing were easier, but greater technical challenges can arise from limited working space and size of instruments 0980: THE EVOLVING ROLE OF SIMULATORS AND TRAINING IN ROBOTIC UROLOGICAL SURGERY: WHICH ASSESSMENT TOOL TO USE? Jonathan K. Makanjuola, Sashi Kommu, Ben Challacombe, Muhammad Shamim Khan, Prokar Dasgupta. The Urology Centre, Guy's and St Thomas' NHS Foundation Trust Kingdom and MRC Centre for Transplantation, NIHR Biomedical Research Centre, King's College London, King's Health Partners, London, UK Aim: The evolution of minimally invasive urological surgery from conventional laparoscopy to robotic platforms has entered a new phase, with large numbers of surgical trainees wanting to learn robotic surgery. Currently, there is no consensus on robotic training. We reviewed the present status of robotic training to guide learning. Methods: MEDLINE, EMBASE and the Cochrane Databases were searched from 1999 to 2011 for systematic reviews of randomised controlled trials, prospective observational studies, retrospective studies and case reports on assessment and training in robotic surgery. Results: There were 40 papers found 2 longitudinal studies, 2 case-control studies with the rest editorials and commentaries on robotic surgery training/assessment. There is evidence that fellowship-trained robotic surgeons initially have superior results than non-fellowship-trained counterparts. There are no well-structured prospective studies that correlate the effectiveness of training with patient morbidity or mortality. Conclusion: There is no consensus on the optimal tools to assess the impact of surgical trainees’ learning curves on patient outcomes. Fellowship training remains the most effective way to gain robotic competences. Studies are needed to provide guidance of robotic-skill acquisition. There are three validated robotic simulators but there is need for focused training and assessment pathway guidelines for robotic surgery training. 0995: UPPER URINARY TRACT UROTHELIAL CARCINOMA: PROGNOSTIC FACTORS Talal Altayeb, Joseph El-Sheikha, Sanjeev Katwal, Graeme Cooksey. Urology Department, Castle Hill Hospital, Hull, UK Aim: Upper urinary tract urothelial carcinoma (UTUC) comprises approximately 10% of renal neoplasm. Minimally invasive endoscopic procedures are associatedwith high recurrent rate; therefore, radical nephro-urectomy (RNU) remains the gold standard. The aim of this study was to examine the oncological outcome of patients with UTUC following RNU. Methods: We conducted a retrospective review of prospectively collected data on patients with UTUC underwent RNU from 2001 to2005. SPSS statistical software programme was used for analysis. Results:Atotal of 26patientswere treatedover the studyperiodwithmedian ageof61yearsand17ofpatientswereofmalegender. Lowerureteral tumours were of higher grade (pT3/pT4) compared to upper localisation (66.6% versus 38.4) and were associated with increased rate of lymph node metastasis (33.3% contrast 18.3% respectively). Overall recurrence rate of 53.8% (n1⁄414) was observed in this cohort. Most of the cases were intravesical recurrence 64.2% (n1⁄49). Favourable oncological outcomewas positively correlated with low grade cancer (pT1/pT2), absence of lymph node involvement and upper ureteral tumour (77%, 100% and 61.5 respectively; p <0.05) Conclusions: This study found that UTUC location and pathological stage are important prognostic factors. These results need to be validated with larger case series. 0997: TYPE OF ANASTOMOSIS: A COMMON VARIANT AFFECTING HOSPITAL STAY IN RADICAL PROSTATECTOMY? Stephanie Guillaumier, Sarvpreet Ubee, Bhupendra Sarmah. Birmingham Heartlands Hospital, Birmingham, UK Introduction: To assess if an interrupted or continuous anastomosis during open radical prostatectomy (ORP) affects the duration of postoperative hospital stay. Materials and methods: 103 consecutive patients underwent an ORRP for localised prostate cancer between 2008 and 2011. 51 patients had interrupted type of vesico-uretheral anastomosis (IRP) and the subsequent 52 had continuous anastomosis (CRP). Retrospective data collection was carried out on hospital stay, cystogram, catheter removal, number of lymph nodes excised and urinary continence. Results: Median (Range) of lymph nodes excised was 6(1-23) in IRP and 6(1-19) for CRP. Median day for drain removal for IRP group was 3 and for CRP was 2. The mean hospital stay for IRP was 4 (4.63) and for CRP was 3 (3.32). 47/51 did not show leakage on cystogram in the IRP group. The mean (median) day for catheter removal was 12.1 (11). 46/52 did not show any leak on a cystogram in the CRP group and the mean (median) day for catheter removal was 13.1 (12). Continence was achieved in 6 months by 35/51 in IRP and 40/52 in CRP. Conclusion: In our experience, continuous anastomosis in ORP appears to be a common variant affecting the post-operative hospital stay. 0998: EXPRESSION PROFILING OF RNA BASED MARKERS OF PROSTATE CANCER IN URINE AND TISSUE SAMPLES Eva Bolton, Diarmaid Moran, Armelle Meunier, Laure Marignol, Donal Hollywood, Thomas Hugh Lynch, Antoinette Perry. Prostate Molecular Oncology Group, Trinity College, Dublin, Ireland Introduction: A critical challenge in prostate cancer (CaP) research is integration of molecular markers into routine clinical use. Differential microRNA expression has successfully differentiated CaP from normal tissue. Diagnostic potential also rests in the non-invasive quantification of other RNA species, such as CaP specific PCA3 transcripts and the TMPRSS2:ERG fusion gene mRNA in urine. Expression of CaP related miRs has not been detailed in urine. Aims: (i) profile urinary expression of 13miRs, definitively up-regulated in CaP, (ii) (determine performance in CaP detection in conjunction with and compared to gold-standard urinary markers PCA3 and TMPRSS2:ERG Methods: Relative quantification data on miR microarray analysis of 24 human prostate cell line samples identified over-expressed miR's, and validated in 85 FFPE tissue samples). Cellular and cell-free total RNA was isolated from 173 urine samples with suspected CaP. PCA3 and TMPRSS2:ERG expression were quantified relative to PGK1 and miR expression calculated relative to let-7e and miR429 by qRT-PCR. Results: 45% of patients (78/173) have CaP. MiR-100 shows 7.9-13.25 fold upregulation in cancer cell lines and tissues relative to benign. Similarly miR-125, miR-24, miR-99a, miR-99b are over-expressed relative to benign. On this basis expression is under investigation using custom TLDAs in the urinary cohort. 1007: IS IT WORTH SAMPLING THE TRANSITIONAL ZONE IN TRANSRECTAL ULTRASOUND GUIDED BIOPSIES OF THE PROSTATE? RANDHAWA K, OBEIDAT S, PETTERSSON BA, POWELL CS. COUNTESS OF CHESTER HOSPITAL Karen Randhawa, Samer Obeidat, Bo Adrian Pettersson, Christopher Powell. Countess of Chester Hospital, Chester, UK Aim: The aim of this study was to evaluate the clinical significance of additional routine transitional zone biopsies in patients undergoing transrectal ultrasound-guided prostate biopsies. Comparison was also made between Gleason grading for cancers found concurrently in both the transitional and peripheral zones. Method: BetweenMay and November 2011,one hundred and seventy-four transrectal ultrasound-guided prostate biopsies were performed, using a 12-core systematic approach with two additional transitional zone biopsies. A retrospective case note analysis was performed reviewing histology obtained from biopsies. Factors assessed were: PSA level, number of cores, percentage of prostate cancer found in peripheral zone, transitional zone and Gleason grade of cancers present. Seven were excluded. Results: Of 167 prostate biopsies performed,81 patients (48.5%) were found to have prostate cancer. Two were transitional zone-confined of Gleason grade 4+3 and 3+3 respectively. In biopsies with concurrent zone