MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM
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CONCLUSIONS: SRMs under AS grew slowly and had a low incidence of requiring surgical intervention or progression. Our data shows a low rate of tumor growth especially with complex cystic masses that exhibit nearly zero net growth. Management of SRMs should routinely include AS as an option in appropriately selected patients. Source of Funding: None Prostate Cancer: Localized VI Moderated Poster Monday, May 19, 2014 1:00 PM-3:00 PM MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM Alessandro Volpe*, Aalst, Belgium; Kamran Ahmed, Prokar Dasgupta, London, United Kingdom; Vincenzo Ficarra, Udine, Italy; Henk Van der Poel, Amsterdam, Netherlands; Alexandre Mottrie, Aalst, Belgium; ERUS board members, Arnhem, Netherlands INTRODUCTION AND OBJECTIVES: The criteria set for sur- geon’s competence before starting robotic surgery are neither struc- tured nor evidence based. The development of structured and validated training curricula represents one of the current priorities in the robotic urologic field. METHODS: A 12-weeks structured training program/curriculum was developed based on a focused group expert panel discussion and used to train 10 fellows from major teaching institutions across Europe. The key components of the curriculum were e-learning, an intensive week of structured simulation laboratory training (virtual reality simulator and dry/wet lab simulation platforms) and modular training in robot- assisted radical prostatectomy (RARP) at each institutions under su- pervision of the mentors. The technical and non- technical skills of the fellows were assessed by the mentors at the end of the program using previously validated GEARS (score 1- 5) and NOTTS (score 1-4) scales. At the end of the training, a full RARP performed by the fellows was video-recorded and blindly assessed by two independent expert robotic surgeons using a dedicated assessment scale. The scores of the fellows were compared with those of two expert robotic surgeons. The educational impact was evaluated with a dedicated questionnaire. RESULTS: The fellows had limited previous console exposure (4 mos, IQR 0-6.5). At the end of the training, the fellows received an average score >4 (4.1-4.7) from their mentors for all the technical skills domains of the GEARS scale, with no negative scores (2). An average score 3.5 was also achieved for the 4 non-technical skills domains of the NOTTS scale, with no negative scores (2). Eight fellows were deemed able to perform a RARP alone by their mentors. At the assessment of the video-recorded RARP, 6 fellows received a sufficient score by the re- viewers for all steps of the surgical procedure and 8 reached an average overall sufficient score. The robotic experts significantly outperformed the fellows for all surgical steps. At the final questionnaire, all fellows considered the program effective in improving their robotic skills and ability to perform the surgical steps of RARP with a mean score of 4.7 on a Likert-type scale (1¼strongly disagree to 5¼strongly agree). CONCLUSIONS: This 12-weeks structured training program was successful to improve the robotic skills of fellows and their ability to perform the surgical steps of RARP. Further studies are needed to define the ideal length and schedule of these programs. This pilot study represents a step towards the definition of validated curricula for RARP and other robotic procedures. Source of Funding: Intuitive Surgical, Inc. MP58-02 OPTICAL BIOPSY OF PROSTATE CANCER THROUGH CONFOCAL LASER ENDOMICROSCOPY Aristeo Lopez*, Kathleen Mach, Daniel Bui, Robert Rouse, Joseph Liao, Stanford, CA INTRODUCTION AND OBJECTIVES: Standard diagnosis of prostate cancer relies on random core biopsies and hematoxylin and eosin (H&E) histopathology. Confocal laser endomicroscopy (CLE) is an in vivo optical biopsy technology that enables real time tissue im- aging with micron-scale resolution similar to histopathology. We applied CLE to fresh, unfixed prostate tissue samples and characterized optical imaging features of normal, benign and malignant prostate. METHODS: With IRB approval, patients (n¼13) scheduled for radical prostatectomy were recruited. Fluorescein (10%), as the tissue contrast agent, was given intravenously prior to prostate removal. Ex vivo probe-based CLE was performed immediately postoperatively with the Cellvizioâ system (Mauna Kea Technologies, Paris). Image correlation with H&E histology was conducted with assistance of a surgical pathologist. RESULTS: No adverse reactions were observed from IV fluorescein administration. CLE was performed on intact prostates (with and without nerve sparing), tissue slices, and tissue cores. Benign prostatic glands were characterized in tissue slices and cores as irregular, lobular structures highlighted by a rim of fluorescence with a dark lumen. Prostate adenocarcinoma demonstrated crowding of smaller glandular structures. CONCLUSIONS: We report optical biopsy of prostate cancer using CLE and a first step towards development of an optical imaging atlas of the prostate parenchyma. Pending further development, CLE may enable true ‘point of care pathology’ and be integrated as part of prostate cancer management. e658 THE JOURNAL OF UROLOGY â Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
Transcript of MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM
e658 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
CONCLUSIONS: SRMs under AS grew slowly and had a lowincidence of requiring surgical intervention or progression. Our datashows a low rate of tumor growth especially with complex cystic massesthat exhibit nearly zero net growth. Management of SRMs shouldroutinely include AS as an option in appropriately selected patients.
Source of Funding: None
Prostate Cancer: Localized VI
Moderated Poster
Monday, May 19, 2014 1:00 PM-3:00 PM
MP58-01MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTICSURGERY TRAINING CURRICULUM
Alessandro Volpe*, Aalst, Belgium; Kamran Ahmed, Prokar Dasgupta,London, United Kingdom; Vincenzo Ficarra, Udine, Italy; Henk Van derPoel, Amsterdam, Netherlands; Alexandre Mottrie, Aalst, Belgium;ERUS board members, Arnhem, Netherlands
INTRODUCTION AND OBJECTIVES: The criteria set for sur-geon’s competence before starting robotic surgery are neither struc-tured nor evidence based. The development of structured and validatedtraining curricula represents one of the current priorities in the roboticurologic field.
METHODS: A 12-weeks structured training program/curriculumwas developed based on a focused group expert panel discussion andused to train 10 fellows from major teaching institutions across Europe.The key components of the curriculum were e-learning, an intensiveweek of structured simulation laboratory training (virtual reality simulatorand dry/wet lab simulation platforms) and modular training in robot-assisted radical prostatectomy (RARP) at each institutions under su-pervision of the mentors. The technical and non- technical skills of thefellows were assessed by the mentors at the end of the program usingpreviously validated GEARS (score 1- 5) and NOTTS (score 1-4)scales. At the end of the training, a full RARP performed by the fellowswas video-recorded and blindly assessed by two independent expertrobotic surgeons using a dedicated assessment scale. The scores ofthe fellows were compared with those of two expert robotic surgeons.The educational impact was evaluated with a dedicated questionnaire.
RESULTS: The fellows had limited previous console exposure(4 mos, IQR 0-6.5). At the end of the training, the fellows received anaverage score >4 (4.1-4.7) from their mentors for all the technical skillsdomains of the GEARS scale, with no negative scores (�2). An averagescore�3.5was also achieved for the 4non-technical skills domains of theNOTTS scale, with no negative scores (�2). Eight fellows were deemedable to perform a RARP alone by their mentors. At the assessment of thevideo-recorded RARP, 6 fellows received a sufficient score by the re-viewers for all steps of the surgical procedure and 8 reached an averageoverall sufficient score. The robotic experts significantly outperformed thefellows for all surgical steps. At the final questionnaire, all fellowsconsidered the program effective in improving their robotic skills andability to perform the surgical steps of RARPwith amean score of 4.7 on aLikert-type scale (1¼strongly disagree to 5¼strongly agree).
CONCLUSIONS: This 12-weeks structured training programwas successful to improve the robotic skills of fellows and their ability toperform the surgical steps of RARP. Further studies are needed todefine the ideal length and schedule of these programs. This pilot studyrepresents a step towards the definition of validated curricula for RARPand other robotic procedures.
Source of Funding: Intuitive Surgical, Inc.
MP58-02OPTICAL BIOPSY OF PROSTATE CANCER THROUGH CONFOCALLASER ENDOMICROSCOPY
Aristeo Lopez*, Kathleen Mach, Daniel Bui, Robert Rouse, Joseph Liao,Stanford, CA
INTRODUCTION AND OBJECTIVES: Standard diagnosis ofprostate cancer relies on random core biopsies and hematoxylin andeosin (H&E) histopathology. Confocal laser endomicroscopy (CLE) isan in vivo optical biopsy technology that enables real time tissue im-aging with micron-scale resolution similar to histopathology. We appliedCLE to fresh, unfixed prostate tissue samples and characterized opticalimaging features of normal, benign and malignant prostate.
METHODS: With IRB approval, patients (n¼13) scheduled forradical prostatectomy were recruited. Fluorescein (10%), as the tissuecontrast agent, was given intravenously prior to prostate removal. Ex vivoprobe-based CLE was performed immediately postoperatively with theCellvizio� system (Mauna Kea Technologies, Paris). Image correlationwithH&Ehistologywasconductedwithassistanceofasurgicalpathologist.
RESULTS: No adverse reactions were observed from IVfluorescein administration. CLE was performed on intact prostates(with and without nerve sparing), tissue slices, and tissue cores.Benign prostatic glands were characterized in tissue slices and coresas irregular, lobular structures highlighted by a rim of fluorescence witha dark lumen. Prostate adenocarcinoma demonstrated crowding ofsmaller glandular structures.
CONCLUSIONS: We report optical biopsy of prostate cancerusing CLE and a first step towards development of an optical imagingatlas of the prostate parenchyma. Pending further development, CLEmay enable true ‘point of care pathology’ and be integrated as part ofprostate cancer management.
