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Good point. Panel discussion should be topic driven with allocated times.
in reply to: Education module for robotic Pyeloplasty #209Patricio,
Great initiative. Submitted my suggestions and feedback.Small animal models have shown that a distance of 4 cm between ports may be feasible depending on the intra-abdominal area of interest that needs to be dissected. Also, the depth of the trocars (not at remote center necessarily) does change the intra-abdominal area of coverage reachable with the arms without clashing. We also notice that in small animal models the distance between trocars changes significantly if you measure and place the trocars with the abdomen distended by the pneumoperitoneum at different pressures and no distension at all.
in reply to: Structured Assessment of Trainee Performance? #197Walid,
I would say around 10 pyeloplasties robotically. This number continues to come down as more incoming fellows are very adept at robotic skills. the fellows we see now can execute robotically on anything you ask them to do. They are merely learning the judgment piece by the time they get to us.
I don’t use reality based sim as much as I’d like for pyeloplasties, but the video review is very helpful. The platform that the fellows use to have their videos and specifically the steps they perform is ideally suited for review and feedback.
Tom
in reply to: Distance between trocars? #196Using a small animal model and an Si robot, we examined the impact of distance between ports, port depth and pneumoperitoneal pressure on the
intra-abdominal working space. We found that a 4-cm distance may be sufficient if surgical area is located within the effective intra-abdominal working space.
.in reply to: Structured Assessment of Trainee Performance? #195Tom,
On average, how many cases do you think trainees will need to become independent to perform a pyeloplasty?
ANDSince you have longitudinal data on your trainees, do you find that simulation exercises expedite their independence? Especially in the last surgical steps you delegate to them?
I think that there is a huge value in watching recorded videos and self evaluate in addition to peer assessment.in reply to: Structured Assessment of Trainee Performance? #194Weighing in here with the caveat that our fellowship uses CSATS for Objective Skills Assessment. In general, we divide the cases into critical steps that confer outcomes. For example: Pyeloplasty – Exposure of UPJ, Fixation of Pelvis (hitch stitch), division and spatulation of pelvis/ureter, posterior anastomosis, anterior anastomosis, (and if resident involved – closure of mesenteric window). For Reimplant – ureteral mobilization, dissection from under uterine artery (female), bladder hitch if desired, detrusor tunnel (detrusorotomy), anchoring and advancement of ureter, closure of tunnel (detrusorrhaphy)
These steps are analyzed by CSATS and also by me in the OR. From the progress the fellows make through each of these steps, I determine to which steps they graduate next. For pyeloplasty, usually the exposure and posterior anastomosis is the last thing the fellows learn to do because I believe these two steps set the tone for success.
For reimplant, the detrusor flap creation and the advancement stitch are the last steps the fellows learn independence on.
If you wanted to get objective scoring data without CSATS, just download Alvin Goh’s paper on GEARS (Global Evalautive Assessment of Robotic Skills) J Urol paper. This will give you a common language with which you can score your trainees.
Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ. Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. The Journal of urology. 2012 Jan 31;187(1):247-52.The angle of entrance of the robot with regards to the area of interest has shown to be of great importance. Animal model seems to support a 4 and 6 cm distance between ports without significant clashing on the outside.
in reply to: Structured Assessment of Trainee Performance? #190Currently I tend to divide the cases- pyeloplasty: dissection/ dismemberment, suturing and thereafter gauge fellow’s involvement. With more cases, I would consider measuring the number of moves/ steps/ sutures as a method to assess skills acquisition.
I am hoping that Tom will elaborate further on this question.in reply to: HIdES for bilateral RAL Pyeloplasties #189Pat, Paul- pictures would be very helpful
in reply to: HIdES for bilateral RAL Pyeloplasties #184Any pictures available to see the set-up? Was dissection transmesenteric or was the colon mobilized?
in reply to: Distance between trocars? #182Running experiments on distance between trocars and surface areas.
Attachments:
You must be logged in to view attached files.in reply to: 3D printing and preop teaching #179Pat, I think this is the future but at sickkids we are considering using 3D printed torsos for different age groups. It is going to be poor man model and not very sophisticated. I think there are some details in the 3D printed model that could be of use in clinical practice.
in reply to: HIdES for bilateral RAL Pyeloplasties #178Pat, how old these patients? Do you make measurements and what is the minimum distance between the trocars? And do you insert the trocar to the remote center?
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