ABSTRACT
ABSTRACT Introduction: We aimed to evaluate the role of remote proctoring during the initial training phases of a robotics curriculum using surgical robot skills simulator exercises. Materials and Methods: Prospective randomized study comprising 36 urology residents and junior staff urologists without previous robotic training. Group 1 (G1) performed exercises without any assistance or support, group 2 (G2) received support from in-person proctor, and group 3 (G3) from a remote proctor through a telementoring system. Qualitative and quantitative analyses were conducted for each exercise and group. Results: The overall score approval rates (OSA) for the different skill exercises were Ring Walk 2 (RW2) 83%, Energy Dissection 2 (ED2) 81%, and Ring Walk 3 (RW3) 14%. RW2 OSA was higher on attempt 3 than on attempt 1 (83.3% vs. 63.9%, p=0.032). ED2 OSA rate was higher in attempt 3 than in attempt 1 (80.6% vs. 52.8%, p=0.002). RW2 OSA was similar among the groups. In ED2, both remote and live assistance were significantly related to upper OSA (G1=47.2%, G2=75.0%, G3=83.3%, p=0.002). RW3 had similar OSA among the groups, which can be explained by the high level of difficulty and low OSA in all the groups. However, in a sensitive quantitative analysis, the mean overall score of the participants in RW3 was higher in both proctored groups (G1=24, G2=57.5, G3=51.5, p=0.042). Conclusion: Robotic performance increased significantly over three attempts for simulation exercises of low, medium, but not high-complexity. Proctoring, either in-person or remotely, has a positive impact on approval performance, particularly in intermediate tasks.
ABSTRACT
Small asymptomatic renal masses are more commonly discovered in elderly patients; however, multiple comorbidities in this population may preclude definitive surgical treatment. In this context, treatment options include active surveillance and ablative techniques. Stereotactic radiosurgery is a relatively innovative method of delivering ablative energy to abdominal organs, with very few human or animal experiences published. We describe our experience treating a patient with a large centrally located renal mass using CyberKnife® stereotactic radiosurgery.
Pequenas massas renais assintomáticas são mais frequentemente encontradas em pacientes idosos; contudo, comorbidades múltiplas nesses pacientes podem contraindicar um tratamento cirúrgico definitivo. Em tal contexto, as opções terapêuticas incluem vigilância ativa e técnicas ablativas. A radiocirurgia estereotáxica é um método inovador que aplica energia ablativa em órgãos abdominais, mas há pouca experiência nesse campo tanto em seres humanos como em animais. Descrevemos nossa experiência com o tratamento de um paciente com uma grande massa renal de localização central, utilizando-se a radiocirurgia esterotáxica com CyberKnife®.
ABSTRACT
Since its initial description, the laparoscopic retroperitoneal lymph node dissection has evolved considerably, from a purely diagnostic tool performed to stage germ cell testicular cancer to a therapeutic operation that fully duplicates the open technique. Herein, we describe the current technique employed at our institution, along with illustrations of all surgical steps, and delineate the refinements of the technique over time.