OBJECTIVETo determine if transtomal rigid endoscopy damages the continence mechanism of continent cutaneous reservoirs. We report the largest and longest series to date from a single institution demonstrating the safety of transtomal rigid endoscopy.MATERIALS AND METHODSWe conducted an institutional review board-approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000 and 2013. Pre- and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated.RESULTSFrom 2000 to 2013, 71 patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow-up was 603 days. Mean age was 58.4 years. The mean number of procedures per patient was 2.7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 28-30Fr access sheath. Two patients reported incontinence postoperatively; 1 patient was treated conservatively by way of indwelling catheter for 1 week and full continence returned. The second patient had small-volume incontinence preoperatively that worsened postoperatively. The procedure uncovered an existing efferent limb-cutaneous fistula. Patients undergoing repeated procedures were not at any higher risk of incontinence. There were no patients that had difficulty with catheterization postoperatively. No surgical revisions were required for worsened continence postoperatively.CONCLUSIONTranstomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous diversions. Transtomal rigid endoscopy allows for safe endoscopic access in these difficult to treat patients. (C) 2015 Elsevier Inc.

ObjectiveTo prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (Connect™; Intuitive Surgical Inc., Sunnyvale, CA, USA) for the da Vinci robot.Materials and MethodsRobotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using Connect. While viewing two‐dimensional, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using two‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. The mentoring interface was rated using a multi‐factorial Likert‐based survey. The Mann–Whitney and t‐tests were used to determine statistical differences.ResultsWe enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative variables of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (P > 0.05). Mentors preferred remote over in‐room telestration (P = 0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases using wired (vs wireless) connections had lower latency and better data transfer (P = 0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting Connect, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions.ConclusionIn a tightly controlled environment, the Connect interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread use of this technology.

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-15 MAINTENANCE OF CONTINENCE WITH RIGID ENDOSCOPIC PROCEDURES IN CONTINENT CUTANEOUS URINARY DIVERSIONS Charles Metcalfe, Jeffery Loh-Doyle, Sameer Chopra, Wesley Yip, Vannita Simma-Chiang, and Matthew Dunn Charles MetcalfeCharles Metcalfe More articles by this author , Jeffery Loh-DoyleJeffery Loh-Doyle More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Wesley YipWesley Yip More articles by this author , Vannita Simma-ChiangVannita Simma-Chiang More articles by this author , and Matthew DunnMatthew Dunn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.398AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is concern that using rigid endoscopes through the stoma of a continent cutaneous urinary diversion damages the continence mechanism. We report the largest and longest series to date from a single institution demonstrating the safety of trans-stomal rigid endoscopy. METHODS We performed an IRB approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000-2013. Pre and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated. RESULTS From 2000-2013, seventy-one patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow up was 603 days (33 days - 6.3 years). Mean age was 58.4 (38-94 years) and 58% were female. The mean number of procedures per patient was 2.7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 24-28Fr access sheath. The majority of indications for treatment included afferent valve stenosis and pouch calculi. Two patients reported continence issues post operatively; one patient was treated conservatively by way of indwelling catheter for one week and the continence returned completely. The second patient had small volume incontinence pre-operatively which worsened postoperatively. The procedure uncovered an already existent pouch-cutaneous fistula, which was revised surgically and resolved the incontinence. Patients with repeated procedures were not found to be at any higher risk of incontinence. There were no patients that had difficulty with catheterization post operatively. No surgical revisions were required for worsened continence post operatively except for the patient. CONCLUSIONS Trans-stomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous urinary diversions. Trans-stomal rigid endoscopy allows for safe endoscopic access in this difficult to treat patient population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e87 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Charles Metcalfe More articles by this author Jeffery Loh-Doyle More articles by this author Sameer Chopra More articles by this author Wesley Yip More articles by this author Vannita Simma-Chiang More articles by this author Matthew Dunn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment (II)1 Apr 20131565 VALIDATION OF DRY LAB EXERCISES FOR ROBOTIC TRAINING USING GLOBAL ASSESSMENT TOOL Patrick Ramos, Jeremy Montez, Casey Ng, Matthew Dunn, Inderbir Gill, and Andrew Hung Patrick RamosPatrick Ramos Los Angeles, CA More articles by this author , Jeremy MontezJeremy Montez Los Angeles, CA More articles by this author , Casey NgCasey Ng Los Angeles, CA More articles by this author , Matthew DunnMatthew Dunn Los Angeles, CA More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Andrew HungAndrew Hung Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dry lab exercise is an inexpensive method to robotic surgical training. We evaluate dry lab modules derived from previously validated Mimic virtual reality exercises for their face, content, construct, and concurrent validity. We also evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance. METHODS Participants were prospectively categorized into two groups: robot novice and expert (≥30 robot cases as primary surgeon). After standardized introduction, participants completed three virtual reality exercises using the da Vinci Skills Simulator as well as the dry lab version of each exercise (Mimic Technologies) on the da Vinci Surgical System. Simulator performance was assessed by the metrics measured by the simulator. Dry lab performance was video-evaluated blind by expert review using the six-metric GEARS tool. Participants completed a post-study questionnaire. Wilcoxon nonparametric test compared performance between groups. Spearman's correlation coefficient assessed simulation to dry lab performance. RESULTS Mean robotic case experience for novices was 0 and 200 (range 30-2000) for experts. Expert surgeons found the dry lab exercises both realistic (median score 8/10 (range 4-10)), and found them very useful for training of residents (9/10 (range 5-10)). Globally, expert surgeons completed all tasks more efficiently (212 vs. 462 sec, p<0.001) and effectively (GEARS score 26 vs. 19, p<0.001) compared to novices. Moreover, experts outperformed novices in each individual GEARS metric (p<0.001). Finally, in comparing the dry lab and simulator performance, there was a moderate correlation overall (r=0.54, p<0.001). Most simulator metrics correlated moderately-strongly with corresponding GEARS metrics (r=0.7, p<0.001). CONCLUSIONS Featured robotic dry lab exercises have face, content, construct, and concurrent validity with the corresponding virtual reality tasks. Additionally, until now, assessment of dry lab exercises has been limited to basic metrics (i.e., time to completion). In establishing construct validity of the dry lab exercises, we demonstrate the feasibility of applying the more global assessment tool GEARS for the first time with dry lab training. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e642 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Ramos Los Angeles, CA More articles by this author Jeremy Montez Los Angeles, CA More articles by this author Casey Ng Los Angeles, CA More articles by this author Matthew Dunn Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Andrew Hung Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121158 INCIDENCE, PREDICTORS AND MANAGEMENT OF STONES IN PATIENTS WITH ORTHOTOPIC NEO-BLADDERS LONG-TERM FOLLOW-UP OF 983 PATIENTS Scott Leslie, Andre Luis de Castro Abreu, Pierre-Marie Lewandowski, Amar Patel, Gus Miranda, Jie Cai, Adrian Fairey, Inderbir S. Gill, Eila C. Skinner, and Matthew Dunn Scott LeslieScott Leslie Los Angeles, CA More articles by this author , Andre Luis de Castro AbreuAndre Luis de Castro Abreu Los Angeles, CA More articles by this author , Pierre-Marie LewandowskiPierre-Marie Lewandowski Los Angeles, CA More articles by this author , Amar PatelAmar Patel Los Angeles, CA More articles by this author , Gus MirandaGus Miranda Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , Adrian FaireyAdrian Fairey Los Angeles, CA More articles by this author , Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author , Eila C. SkinnerEila C. Skinner Los Angeles, CA More articles by this author , and Matthew DunnMatthew Dunn Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1382AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with urinary diversions are at increased risk of urolithiasis. Different techniques of bladder substitution have evolved over the years. We discuss the incidence, site of stones, predictors and management of stone disease in the different types of orthotopic reconstructions, Kock urethra (KU), T-pouch (TP) and Studer neobladder (SN), performed at our institution. METHODS The records of 983 consecutive patients who underwent a radical cystectomy and orthotopic bladder reconstruction between April 1987 and November 2004 were reviewed. Information regarding the type of bladder substitution, the stone characteristics and the subsequent management of the calculi was obtained. Differences in surgical technique (including the use of staples) and other risk factors for urolithiasis were analyzed to determine the impact they had on stone formation and treatment. RESULTS Of the 983 patients identified, 445 (45%) had a KU, 364 (37%) had a TP, and 174 (18%) had a SN. Overall 80 (8%) patients developed stones and the median time to the first stone episode was 3.8 years. Overall estimated stone-free survival at 5 and 10 years were 92% and 87% respectively. Stones occurred in 9.9% of patients who had a KU, 9.6% for those that had a TP and 4.8% for those that had a SN (p = 0.022). The table demonstrates that patients with a KU or TP formed stones almost exclusively within the bladder substitution. In contrast, stones within the SN group most commonly occurred in the upper tracts. The stone size was larger in the KU and TP groups, and these stones were associated with staples in 58% of cases. The management of the stones was also different with 66.7% of SN stones managed conservatively, whereas 82.3% of KU or TP stones required endoscopic management. The stone clearance rate following treatment of the first stone was 95.4%. However, the recurrence rate following treatment of the first stone was 22.6%. CONCLUSIONS The differences in surgical technique, including use of staples in the KU group and an afferent nipple valve in both the KU and TP group, are likely contributing factors to the incidence, site and size of calculi when compared to the SN group. Larger stones, located in the neo-bladder of the KU and TP groups often necessitated endoscopic management. When compared to both the KU and TP groups, the SN group had a lower incidence of stone disease and less commonly required surgical intervention to manage stones. Kock Urethra or T-Pouch Studer neobladder p-value Stone in neobladder or afferent nipple valve 91.2% 16.7% 0.001 Stone associated with staple 58% 0% 0.03 Stone > 1 cm 40.4% 0% 0.049 Conservative treatment 12.3% 66.7% 0.009 Endoscopic treatment 82.3% 16.7% 0.009 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e469-e470 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Leslie Los Angeles, CA More articles by this author Andre Luis de Castro Abreu Los Angeles, CA More articles by this author Pierre-Marie Lewandowski Los Angeles, CA More articles by this author Amar Patel Los Angeles, CA More articles by this author Gus Miranda Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Adrian Fairey Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Eila C. Skinner Los Angeles, CA More articles by this author Matthew Dunn Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy I1 Apr 2012861 EXTERNAL VALIDITY OF STANDARDIZED TASKS FOR EVALUATION AND TEACHING OF ROBOTIC TECHNICAL SKILLS Alvin Goh, Andrew Hung, Isuru Jayaratna, Kara Teruya, Mukul Patil, Matthew Dunn, and Inderbir Gill Alvin GohAlvin Goh Los Angeles, CA More articles by this author , Andrew HungAndrew Hung Los Angeles, CA More articles by this author , Isuru JayaratnaIsuru Jayaratna Los Angeles, CA More articles by this author , Kara TeruyaKara Teruya Los Angeles, CA More articles by this author , Mukul PatilMukul Patil Los Angeles, CA More articles by this author , Matthew DunnMatthew Dunn Los Angeles, CA More articles by this author , and Inderbir GillInderbir Gill Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.954AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a growing need for primary acquisition of technical skills to occur outside the operating room. Building on initial validation, we demonstrate external face and construct validity of a standardized model of structured training tasks designed to measure robotic skills called the Fundamentals of Robotic Surgery (FRS). METHODS A broad sample of 49 subjects from various geographic regions, including 11 expert robotic surgeons (completed >30 robotic cases) and 38 urology trainees (ranging from post-graduate year 3 to 8) were evaluated. Standardized instructions and video demonstration were given to each subject. Participant performance of 4 structured robotic tasks (horizontal mattress suture, clover pattern resection, 3-dimensional peg placement, circular target needle placement) was measured using a scoring system based on efficiency and precision. To assess face and content validity, subjects were asked to rate the curriculum on a 5-point Likert scale according to 1) difficulty, 2) similarity to skills required for robotic surgery, 3) usefulness for skills evaluation, 4) usefulness in skills training, and 5) requirement for proficiency. RESULTS Experts consistently performed better than trainees in all 4 tasks of FRS (Table 1). Experts and novices agreed FRS was appropriately challenging and incorporated skills required for robotic surgery (p>0.05). Greater than 96% of respondents thought the structured tasks were useful for robotic skills assessment and training. Table 1. Mean task performance scores (lower is better) Task 1 Task 2 Task 3 Task 4 Experts (n=11) 153±38 147±34 87±22 167±53 Novices (n=38) 265±64 189±67 203±71 315±91 p-value <0.001 <0.001 <0.001 <0.001 CONCLUSIONS We confirm external face, content, and construct validity of a structured inanimate robotic skills curriculum (FRS) in a diverse cohort. Performance on FRS appears to correlate with level of robotic technical ability. This model may be integrated in a comprehensive robotics training program. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e351 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alvin Goh Los Angeles, CA More articles by this author Andrew Hung Los Angeles, CA More articles by this author Isuru Jayaratna Los Angeles, CA More articles by this author Kara Teruya Los Angeles, CA More articles by this author Mukul Patil Los Angeles, CA More articles by this author Matthew Dunn Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyPediatrics1 Apr 2010V1109 LAPAROENDOSCOPIC SINGLE SITE (LESS) NEPHRECTOMY IN CHILDREN: FROM INFANTS TO ADOLESCENTS Chester Koh, Manuel Eisenberg, Andre Berger, Ricardo Brandina, Ryan Dorin, Roger De Filippo, Andy Chang, Brian Hardy, Matthew Dunn, Monish Aron, Inderbir Gill, and Mihir Desai Chester KohChester Koh More articles by this author , Manuel EisenbergManuel Eisenberg More articles by this author , Andre BergerAndre Berger More articles by this author , Ricardo BrandinaRicardo Brandina More articles by this author , Ryan DorinRyan Dorin More articles by this author , Roger De FilippoRoger De Filippo More articles by this author , Andy ChangAndy Chang More articles by this author , Brian HardyBrian Hardy More articles by this author , Matthew DunnMatthew Dunn More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present our technique and initial experience with LESS nephrectomy for non-functioning kidneys in 8 pediatric patients. METHODS In this video we present a 5 week old male with a weight of 5.1 kg who was found to have a large hydronephrotic non-functioning left kidney diagnosed on prenatal ultrasound and confirmed with computerized tomography. A laparoscopic left nephrectomy was performed exclusively with a single site technique through a multi-channel single port (TriPort, Advanced Surgical Concepts/Olympus) and a 12 mm umbilical incision. The procedure began with medial retraction of the left colon and the identification and initial dissection of the kidney. Once identified, the renal pelvis was incised and drained. The left ureter was completely mobilized, divided, and used for retraction. The renal hilum was then dissected and divided between metal clips. The remaining attachments were dissected free. The kidney was placed in an Endo Catch bag (Covidien) and extracted via the single port incisional site. RESULTS Operative time was 133 minutes and estimated blood loss (EBL) was minimal. Hospital stay was 1.4 days and uneventful. Virtually no scar was noted at the 5 week mark following the LESS nephrectomy. Our current experience is comprised of 8 pediatric LESS nephrectomies (7 left, 1 right) performed in 5 female and 3 male patients with mean age of 6 years (range: 1 month - 15.6 years) with weights ranging from 5.1 kg to 58 kg and a mean BMI of 17.3 (range: 13.3 - 24.8). Mean operative time was 132 minutes (range: 85 - 176 minutes), mean incision length was 16 mm (range 12 - 25mm), mean EBL <5 cc's, and mean hospital stay 1.5 days (range: 1.0 - 2.1 days). In 5 cases a 3mm accessory miniport was utilized. Postoperative hydrocele was observed in 2 cases. CONCLUSIONS To our knowledge this is the youngest and smallest patient in which a LESS procedure has been performed to date. LESS nephrectomy for benign conditions can be safely performed in selected pediatric patients, providing virtually scarless results. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e430 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chester Koh More articles by this author Manuel Eisenberg More articles by this author Andre Berger More articles by this author Ricardo Brandina More articles by this author Ryan Dorin More articles by this author Roger De Filippo More articles by this author Andy Chang More articles by this author Brian Hardy More articles by this author Matthew Dunn More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2009LESSONS LEARNED FROM A COMPARISON OF ADULT AND PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTIES Paul J Kokorowski, Shahin T Chandrasoma, Matthew Dunn, Roger De Filippo, Andy Chang, Clayton S Lau, and Chester J Koh Paul J KokorowskiPaul J Kokorowski More articles by this author , Shahin T ChandrasomaShahin T Chandrasoma More articles by this author , Matthew DunnMatthew Dunn More articles by this author , Roger De FilippoRoger De Filippo More articles by this author , Andy ChangAndy Chang More articles by this author , Clayton S LauClayton S Lau More articles by this author , and Chester J KohChester J Koh More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61086-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LESSONS LEARNED FROM A COMPARISON OF ADULT AND PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTIES." The Journal of Urology, 181(4S), pp. 383–384 © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKojima Y, Umemoto Y, Mizuno K, Tozawa K, Kohri K and Hayashi Y (2018) Comparison of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Adults and Children: Lessons LearnedJournal of Urology, VOL. 185, NO. 4, (1461-1468), Online publication date: 1-Apr-2011. Volume 181Issue 4SApril 2009Page: 383-384 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Paul J Kokorowski More articles by this author Shahin T Chandrasoma More articles by this author Matthew Dunn More articles by this author Roger De Filippo More articles by this author Andy Chang More articles by this author Clayton S Lau More articles by this author Chester J Koh More articles by this author Expand All Advertisement PDF downloadLoading ...