Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

Purpose: Radical cystectomy is the gold standard for nonmetastatic muscle invasive bladder cancer and for refractory nonmuscle invasive disease. Compared to open radical cystectomy, robot-assisted radical cystectomy has been shown to provide comparable early oncologic outcomes and improved perioperative outcomes. However, there is a paucity of data on long-term oncologic outcomes and concerns about a higher incidence of local recurrence after robot-assisted radical cystectomy.

Development and validation of a tool for non-technical skills evaluation in robotic surgery-the ICARS system.

Background: Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment.

Training in minimally invasive surgery in urology: European Association of Urology/International Consultation of Urological Diseases consultation.

Objectives: To describe the progress being made in training for minimally invasive surgery (MIS) in urology.

Methods: A group of experts in the field provided input to agree on recommendations for MIS training. A literature search was carried out to identify studies on MIS training, both in general and specifically for urological procedures.

Should surgical outcomes be published?

Despite publishing surgical outcomes being a positive step forwards in the progression of England's healthcare system, it has no doubt been faced with criticism and reservations. This review article aims to discuss the pros and cons of publishing individual surgical outcomes, as well as the challenges faced. Publishing outcomes requires data from a number of sources such as national clinical audits, hospital episode statistics, patient-reported outcomes, registers and information from revalidation.

An overview of the use and implementation of checklists in surgical specialities - a systematic review.

Introduction: Surgical procedures present an immense risk to patients, and adverse patient outcomes are frequently due to substandard non-technical skills amongst surgical staff. The implementation of a 19-item Surgical Safety Checklist, developed by the World Health Organization, is being enforced in operating theatres globally. The objective is to systematically analyze published literature to assess the use of the WHO Surgical Safety Checklist and their impact in on patient safety.

Performance of technology-driven simulators for medical students--a systematic review.

Background: Simulation-based education has evolved as a key training tool in high-risk industries such as aviation and the military. In parallel with these industries, the benefits of incorporating specialty-oriented simulation training within medical schools are vast. Adoption of simulators into medical school education programs has shown great promise and has the potential to revolutionize modern undergraduate education.

Face and content validation of the prostatic hyperplasia model and holmium laser surgery simulator.

Objective: Although a number of simulators have been introduced for prostate surgery, none have undergone validation for holmium laser enucleation of the prostate training. This study was carried out to assess the face and content validities as well as feasibility and acceptability of the new prostatic hyperplasia model and prostate surgery simulator for holmium laser enucleation of the prostate.

Design: This is a prospective, observational, and comparative study.

A review of the available urology skills training curricula and their validation.

Background: The transforming field of urological surgery continues to demand development of novel training devices and curricula for its trainees. Contemporary trainees have to balance workplace demands while overcoming the cognitive barriers of acquiring skills in rapidly multiplying and advancing surgical techniques. This article provides a brief review of the process involved in developing a surgical curriculum and the current status of real and simulation-based curricula in the 4 subgroups of urological surgical practice: open, laparoscopic, endoscopic, and robotic.

Current status and effectiveness of mentorship programmes in urology: a systematic review.

The objectives of this review were to identify and evaluate the efficacy of mentorship programmes for minimally invasive procedures in urology and give recommendations on how to improve mentorship. A systematic literature search of the PubMed/Medline databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In all, 21 articles were included in the review and divided into four categories: fellowships, mini-fellowships, mentored skills courses and novel mentorship programmes.

Learning curves for urological procedures: a systematic review.

Objective: To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Patient And Methods: The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included.

Measuring the surgical 'learning curve': methods, variables and competency.

Objectives: To describe how learning curves are measured and what procedural variables are used to establish a 'learning curve' (LC). To assess whether LCs are a valuable measure of competency.

Patients And Methods: A review of the surgical literature pertaining to LCs was conducted using the Medline and OVID databases.

Development and content validation of a surgical safety checklist for operating theatres that use robotic technology.

Objectives: To identify and assess potential hazards in robot-assisted urological surgery. To develop a comprehensive checklist to be used in operating theatres with robotic technology.

Methods: Healthcare Failure Mode and Effects Analysis (HFMEA), a risk assessment tool, was used in a urology operating theatre with innovative robotic technology in a UK teaching hospital between June and December 2011.

Introducing the productive operating theatre programme in urology theatre suites.

Background: The Productive Operating Theatre (TPOT) is a theatre improvement programme designed by the UK National Health Service. The aim of this study was to evaluate the implementation of TPOT in urology operating theatres and identify obstacles to running an ideal operating list.

Method: TPOT was introduced in two urology operating theatres in September 2010.

Ureteric injury: a challenging condition to diagnose and manage.

Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively. In addition to compromising patient safety, missed ureteric injuries frequently result in litigation.

Current status of robot-assisted partial nephrectomy.

What's known on the subject? and What does the study add? The use of robotic assistance for the partial nephrectomy procedure has emerged as an alternative that may help some of the technical challenges of laparoscopic partial nephrectomy. The main concerns in laparoscopic partial nephrectomy relates to a steeper 'learning curve', prolonged warm ischaemia times and the potential for postoperative haemorrhage. The article delineates the dynamics of patient preparation, the surgical team, surgical technique & post-operative care to conclude that robotic-assisted partial nephrectomy is a viable alternative to both open and laparoscopic techniques.

Standard versus tubeless percutaneous nephrolithotomy: a systematic review.

Objective: This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL.

Methods: The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included.

Decision making in urological surgery.

Context: Non-technical skills are important behavioural aspects that a urologist must be fully competent at to minimise harm to patients. The majority of surgical errors are now known to be due to errors in judgment and decision making as opposed to the technical aspects of the craft.

Evidence Acquisition: The authors reviewed the published literature regarding decision-making theory and in practice related to urology as well as the current tools available to assess decision-making skills.

Quality-of-care framework in urological cancers: where do we stand?

What's known on the subject? and What does the study add? Provision of high-quality care necessitates the identification and measurement of relevant quality indicators. Urological surgery currently does not have a validated quality-of-care framework to guide surgical quality improvement. This article aims to delineate quality of care processes, current status of quality indicators for major urological cancers as well as recommend a provisional framework for evaluation of quality for urological procedures.

Urology training: past, present and future.

What's known on the subject? and What does the study add? Dedicated training hours for surgeons are falling as the complexity of techniques and patient expectations are increasing. Urologists therefore need to train in more sophisticated and effective ways. This article looks at past and current urological training and suggests emerging and innovative ways to teach the next generation of urologists.