The transferability of the minimal invasive surgeon's skills to open surgery.

BACKGROUND: Robot-assisted laparoscopic surgery has gained popularity, which has contributed to a decrease in the number of open procedures. Hence a growing concern regarding the ability of laparoscopically trained surgeons to perform open surgery (e.g. due to bleeding complications) has been raised. The aim of the study was to investigate the ability of conversion to open surgery following exclusively robotic or laparoscopic training. METHODS: Thirty-six medical students were randomized into three groups: Open surgery, laparoscopy, and robot-assisted laparoscopy. All underwent intensive simulation training in the allocated surgical modality. Subsequently, all study subjects performed an open bowel anastomosis in a pig model where anastomoses were tested for resistance to pressure and leak as a surrogate marker of surgical quality. RESULTS: The primary endpoint was the surgical quality of an open surgery model assessed as, leak pressure, which was 80.01 ± 36.16 mmHg in the laparoscopic training group, 106.57 ± 23.03 mmHg in the robotic training group, and 133.65 ± 18.32 mmHg in the open surgery training group (mean, SD). We found that there were no significant differences between the open surgery training group and the robotic training group whereas a significant difference was found when comparing laparoscopic and open surgery training groups in favor of open procedure training (p < 0.001). CONCLUSION: In a surrogate open surgery model based on bowel anastomosis, we found that skills acquired through practice on robotic simulation platforms were not significantly worse when compared to skills acquired through training in open surgery, whereas skills acquired from laparoscopic training were significantly poorer when compared to open surgery practice.

Asymptomatic microscopic hematuria as a predictor of neoplasia in the urinary tract.

OBJECTIVE: The Danish hematuria guidelines were revised in January 2016. Before revision, it was recommended that asymptomatic microscopic hematuria in patients more than 40 years old should be routinely urologically investigated. In the revised guidelines, patients with asymptomatic microscopic hematuria are not recommended to be investigated, irrespective of age. The purpose of this study was to investigate whether asymptomatic microscopic hematuria was predictive of neoplasia of the urinary tract in a referred cohort of patients. METHODS: All patients older than 40 years referred from primary care to private clinics and public hospitals in the Central Denmark Region for evaluation of asymptomatic microscopic hematuria in a 2 year period from January 2014 to December 2015 were included retrospectively. All patients had been routinely investigated with computed tomography urography and outpatient flexible cystoscopy. Patients' age and gender were recorded and the final diagnosis after full investigation was retrieved. RESULTS: In total, 1305 patients (492 males and 813 females) were included. Eleven patients (0.8%) were diagnosed with neoplasia in the urinary tract, including non-invasive Ta bladder tumor (n = 6), benign tumors in the kidney (n = 2), invasive bladder cancer (n = 2) and carcinoma in situ in the urinary bladder (n = 1). None of the patients had renal cancer or upper urinary tract tumors as the final diagnosis. CONCLUSION: A minority of patients with malignancies or non-invasive tumors would have been missed based on the revised Danish hematuria referral pathways.

Outcomes of haematuria referrals: two-year data from a single large university hospital in Denmark.

OBJECTIVE: The aim of this study was to review haematuria referrals to a large university hospital in Denmark, based on the previous Danish guidelines for haematuria referral (before January 2016), to evaluate the pattern of referrals and the cancer detection rates and compare these with the current guidelines. MATERIALS AND METHODS: A retrospective study was undertaken of all patients referred from primary care for the evaluation of haematuria from January 2013 to December 2014. All patients underwent cystoscopic examination and upper urinary tract evaluation using computed tomography. Patients' demographics, type of haematuria, presence of urinary symptoms and cancer detection rates were recorded. RESULTS: The study included 1577 patients, with a mean age of 63 years (range 16-96 years). Of these, 56.4% had visible haematuria (VH) and 43.6% were referred for non-visible haematuria (NVH). In total, 228 malignancies were detected (14.5% cancer detection rate). Overall, 11.2% of patients had bladder cancer, 1.8% renal cancer and 0.4% upper tract transitional cell carcinoma. In the VH group, 205 malignancies were detected (23% cancer detection rate). The detection rate was higher for those with asymptomatic VH (24.6%) than for those with symptomatic VH (15.4%). The cancer detection rate for symptomatic NVH was 9.1%, with only three cancers diagnosed in those younger than 60 years of age. For asymptomatic NVH, the cancer detection rate was only 1.5%, with a total of eight urological malignancies diagnosed in patients aged 60 years or older. CONCLUSIONS: The new Danish referral pathway has an acceptable capture rate for patients presenting with haematuria of all severities. The overall cancer detection rate of 14.5%, and 23% for patients with VH in this study, is an important validation of previous studies. A cancer detection rate of greater than 30% was shown in patients with VH over 70 years old.