Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

ABSTRACT Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

Prevalence and associated factors of enuresis in turkish children

OBJECTIVE: Enuresis, which is frequently diagnosed amongst schoolchildren, is an important psychosocial problem for both parents and children. In the present study we aimed to determine the prevalence and associated factors of enuresis in Turkish children and to identify common methods for its management. MATERIALS AND METHODS: A cross sectional epidemiological study was performed among primary school children living in Ankara, Turkey. A self-administered questionnaire was prepared for this study and distributed to the parents of 1,500 schoolchildren whom aged 6-12 years. RESULTS: Of the 1,500 questionnaires distributed, 1,339 (89 percent) were completed. The overall prevalence of nocturnal and diurnal enuresis were 17.5 percent (n = 234) and 1.9 percent (n = 25), respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased number of people sleeping in the child's room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2 percent. The most preferred treatment option for enuresis was medications (59.5 percent), whereas alarm treatment was the least preferred (2.4 percent). CONCLUSIONS: Our results with enuresis prevalence and associated factors were comparable to other epidemiologic studies from various countries. Furthermore we demonstrated that families in Turkey do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.