Louis Eichel, M.D.
Clinical Assistant Professor of Urology
University of Rochester
Director of Minimally Invasive Surgery
Center For Urology
Rochester, NY
Plenary Session Highlights from August 17^th, the first day of the 2006 Annual World Congress of Endourology

Overview of the Posters Presented August 17^th:

• A Total of 95 posters and videos

– Radical prostatectomy 55

– Pyeloplasty 12

– Cystectomy 10

– Radical/Donor nephrectomy 4

– Partial nephrectomy 3

– Nephroureterectomy 1

– Pelvic Node Dissection 1

– Bladder Augmentation 2

– Sacrocolpopexy 2

– Ureteral Surgery 3

– Appendicovesicostomy 1

– Vaso-Vasostomy 1

Specific Session highlights included:

Robot-Assisted Donor Nephrectomy

• MP1-13 Dasgupta et al

– 3 patients daVinci-assisted donor nephrectomy

– OR time 205-260 min, EBL 125-366cc

– Warm ischemia 120-140 sec

• MP1-20 Hubert et al

– 37 patients daVinci-assisted donor nephrectomy

– OR time 183+/-31 min, EBL< 100cc,

– Warm ischemia time 6 +/- 2 min

• No patients with delayed graft function

• Advantages of robotics may expand the number of laparoscopic donor nephrectomies performed.

Computer Simulation
Does Prior Video Game Exposure Enhance Robotic Surgical Performance?

• MP5-01 Harper et al:

– 242 preclinical medical students were screened for video game participation as well as other activities such as sports, musical instruments, etc.

– Top 10 and bottom 10 video game participants were tested for skill with tying knots.

– Video game playing was inversely correlated with the ability to suture robotically while athletes and musicians were more adept.

Virtual Reality Trainers: Are They Effective?

• VP1-17 Vlaovic et al: Construct Validity of the Lapmentor Simulator

– 56 experienced laparoscopic surgeons were compared to similar groups of medical students, residents, and attending surgeons with minimal laparoscopic experience on a single laparoscopic task

– Performance scores accurately correlated with level of experience indicating excellent construct validity

• MP5-09 and MP5-10 Schout et al: Construct Validity of the Uromentor, A Virtual Reality Simulator for Endourological Procedures

– 10 interns and 21 experienced urologists performed a practice procedure using the Uromentor and were scored based on performance by several criteria. 70 urologists also rated the realistic nature of the model after performing a procedure on it

– Performance scores accurately predicted expert from novice indicating excellent construct validity. The questionnaires indicated excellent face validity

• MP5-14 Henderson et al: Virtual Reality Percutaneous Nephrostomy Simulator: A Stab In The Dark Or A Valid Training Tool?

– 20 novices were compared to 10 experts performing percutaneous nephrostomy on a virtual reality trainer. The subjects filled out questionnaires about the realistic nature of the model

– Performance scores accurately predicted expert from novice indicating excellent construct validity.

– Questionnaires indicated excellent face validity

Robotic Surgical Education

• MP5-07 Haleblian et al Training For Robotic Radical Prostatectomy: A Strategy For Residents

– Residents receive technology equipment orientation and suturing training.

– Observation of 5 cases

– Assist on 5 cases

– Act as primary surgeon on 3 separate portions of the operation based on successive level of difficulty.

– Data regarding proficiency is collected.

– The residents became more proficient over time

– The first two chief residents trained using this system now perform robotic prostatectomy in their own practice.

Computerized Surgical Treatment Planning

• MP5-16 Tanaka et al: Computerized Planning Of Cryosurgery Using Bubble Packing

– Computerized treatment planning for prostate cryoablation to improve accuracy

– Bubble packing is a technique for uniformly distributing ellipsoidal elements within a 3D reconstruction of the prostate

– Using a TRUS derived 3D prostate model, Temperature / Volume histograms showed that bubble packing can successfully find a configuration of needles that freezes the prostate reliably.

– This technology may extrapolate to this and other forms of needle based tissue ablation

• MP28-05 Thueroff et al: Prostate Cancer Treatment With HIFU by Ablatherm With Real Time Integrated Imaging

– Computer controlled robotic ultrasound probe with integrated HIFU generator

– A 3D reconstruction based on TRUS is created and computer assists in treatment planning and execution.

– Shortens learning curve for technique and treatment times

Minirobotic-Assisted Surgery

• V5-01Joseph et al: Microrobotics In Urology: Video Demonstration Of Microrobot-Assisted Laparoscopic Prostatectomy and Nephrectomy In A Canine Model

– Experimental mini robotic camera with 360 degree rotational capability was placed into the insufflated abdomen and used to visualize the surgical field during laparoscopic prostatectomy and nephrectomy.

– Proof of concept project for further refinement and development of mini and micro-robotic instrumentation.

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