ABSTRACT
Introduction &Objective: Surgical missions are still largely on pause due to COVID-19, leading to missed opportunities for skill sharing between high-income and middle to low-income countries. New commercially available augmented reality (AR) technology facilitates surgical training, allowing mentors in one country to virtually train and skill-share with a mentee in another country during surgical cases in real-time. We hypothesize that AR technology is an effective live surgical training and mentorship modality. Method(s): To evaluate perceived effectiveness of AR technology in global urologic surgery training, surgeon mentors in the USA and UK worked with mentees in Benin performing surgical cases using the Proximie AR system. Proximie includes audiovisual capabilities allowing a mentor in any location to provide a mentee with real-time guidance during the procedure. Following each case, mentor and mentee individually completed a questionnaire assessing the technology. Result(s): Trainers reported AR technology as easy to set-up and use in 73.3% of cases while the trainee reported easy set-up and use in 100% of cases. The visual quality was acceptable to trainers in 60% of cases and "looks like I'm there" in 40%. Visual input/ability to draw on screen had high impact in 80% of cases, with trainers rating the ability to provide anatomical guidance as invaluable or significant in 93.4% of cases. Audio and anatomical guidance had a significant impact for the trainee in 100% of cases. The quality of virtual training v. in-person training was equivalent in 100% of cases for the trainee while trainers found virtual training inferior in 66.7% of cases and equivalent in only 6.7% of cases. Difficulty connecting occurred often in only 1% of cases for trainers but in 12.5% of cases for the trainee. Trainers reported delay or time lag while using the technology in 40% of cases, with lag being problematic in 12.5% of cases. In contrast, the trainee reported rarely experiencing delay or time lag while using the technology in 100% of cases. Conclusion(s): AR technology is useful in facilitating real-time surgical mentorship during the COVID-19 pandemic. The Proximie technology provides visualization that is acceptable and audiovisual capabilities that have significant positive impact on successful case completion. Though AR technology presents its own set of challenges such as difficulty in connecting virtually between trainer and trainee as well as delay or time lag during surgical cases, AR technology may prove a welcome alternative when in-person training is unavailable or limited.
ABSTRACT
Introduction & Objective: COVID-19 continues to have a profound effect on urolithiasis management with varying recommendations for prioritization across different healthcare systems. We used the Delphi method to obtain international consensus recommendations for managing urolithiasis during the pandemic. Methods: 53 key opinion leaders from 36 countries within the Endourological Society contributed to a three-round Delphi process addressing the general organisation, inpatient and outpatient management and follow-up care of urolithiasis patients to determine best practices for suspension and resumption of care. Results: Consensus was achieved in 64/84 (76%) questions allowing the following recommendations to be made for the management of Urolithiasis during the pandemic. 1 Consultations should ideally be delivered via telephone or video conferencing, prioritizing patients with Infection, acute kidney injury, pain including acute ureteric colic and visible haematuria. 2 The Surgical focus should be to reduce the risk of complications even if it means a planned secondary procedure 3 Surgery should be reserved for high risk patients (solitary kidney, bilateral ureteral obstruction), infected patients, patients at risk of acute kidney injury or those with uncontrollable pain. 4 Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. 5 ESWL should be continued for ureteric stones but not for asymptomatic renal stones 6 Spinal Anaesthesia was recommended for distal Ureteric Stones under 10mm 7 For symptomatic renal stones, Flexible ureterorenoscopy (FURS) was recommended for 11-20mm and PCNL/ ECIRS for stones >20mm 8 Following Uncomplicated URS/FURS “Stent-on-astring” was recommended for stones 5-20mm at all positions, with “stent and cystoscopic removal” for stones >20mm at all locations 9 Following Complicated URS/FURS stent and cystoscopic removal was recommended for all stone sizes and locations. 10 Following PCNL, some form of drainage was recommended for all complicated PCNLs and for uncomplicated PCNL for stones >11mm. 11 Surgical education should be maintained for trainees involved in the patients care. 12 Follow up imaging should continue for conservatively and actively treated ureteric colic and for patients with symptomatic renal stones 13 Imaging follow up can be deferred for asymptomatic prior stone formers including those with an established renal stone. Conclusions: These recommendations can be applied currently during the ongoing Covid-19 pandemic and be used as a framework for practice during a future catastrophic event that impacts the practice of renal and ureteric stone surgery.