A Randomized Comparison of 2 Robotic Virtual Reality Simulators and Evaluation of Trainees' Skills Transfer to a Simulated Robotic Urethrovesical Anastomosis Task.

OBJECTIVE: To determine, via a randomized comparison study, whether robotic simulator-acquired skills transfer to performance of a urethrovesical anastomosis (UVA) on a 3-dimensional-printed bladder model using the da Vinci Robot. MATERIALS AND METHODS: Medical students, surgical residents, and fellows were recruited and divided into 2 groups: Group 1 (G1) (junior trainees) and Group 2 (G2) (senior trainees). Participants were randomized to identical simulator training curricula on the dV-Trainer (dV-T) or da Vinci Surgical Skills Simulator (dVSSS). Participants then completed a UVA task on a 3-dimensional-printed bladder model using the da Vinci robot. Three blinded expert robotic surgeons rated videotaped performances of the UVA task using validated assessment tools, namely, the Global Evaluative Assessment of Robotic Skills (GEARS; overall procedure) and Robotic Anastomosis Competence Evaluation (RACE; specific to UVA). RESULTS: Thirty-nine participants (G1 = 23 and G2 = 16) completed the study. Participants in G2 had significantly more simulation and surgical experience compared with G1 (P <.05). UVA scores of the dVSSS group were higher compared with dV-T (GEARS: P = .09; RACE: P = .01). In the G1 cohort, dVSSS scores were significantly higher than dV-T (GEARS: P = .01; RACE: P <.01). In the G2 cohort, scores were statistically similar (GEARS: P = .32; RACE: P = .91). CONCLUSION: Compared with the dV-T, the dVSSS training led to superior GEARS and RACE scores for performance of the UVA task in junior trainees, but not in senior trainees. The dVSSS can be used to improve surgical skills acquisition in less experienced trainees in a safe and effective manner.

Case: Spontaneous regression of post-radical prostatectomy prostate-specific antigen elevation without adjuvant therapy in a patient with lymph node metastasis.

Prostate cancer remains the most frequently diagnosed cancer among men. The combination of clinical stage, serum prostate-specific antigen (PSA), and Gleason score (biopsy) assists in predictive assessment of pathological stage and prognosis. Furthermore, pathological criteria, including Gleason score, surgical margin status, extracapsular extension, seminal vesicle invasion, and lymph node involvement, provide prognostication in patients undergoing radical prostatectomy (RP). In this paper, we present a case of a patient with high-risk prostate cancer with persistent PSA elevation post-RP who experiences a complete regression of PSA without any adjuvant therapy. To the authors' knowledge, such a finding has not been described in the literature previously.