Virtual reality simulators are increasingly used to gain robotic surgical skills. This study compared use of the da Vinci Surgical Skills Simulator (dVSSS) to the standard da Vinci (SdV) robot for skills acquisition in a prospective randomized study. Residents from urology, gynecology, and general surgery programs performed three virtual reality tasks (thread the ring, ring rail, and tubes) on the dvSSS. Participants were then randomized to one of the two study groups (dVSSS and SdV). Each participant then practiced on either the dVSSS or the SdV (depending on randomization) for 30 min per week over a 4-week time period. The dVSSS arm was not permitted to practice ring rail (due to no similar practice scenario available for the SdV group). Following 4 weeks of practice, participants performed the same three virtual reality tasks and the results were recorded and compared to baseline. Overall and percent improvement were recorded for all participants from pre-test to post-test. Two-way ANOVA analyses were used to compare the dVSSS and SdV groups and three tasks. Initially, 30 participants were identified and enrolled in the study. Randomization resulted in 15 participants in each arm. During the course of the study, four participants were unable to complete all tasks and practice sessions and were, therefore, excluded. This resulted in a total of 26 participants (15 in the dVSSS group and 11 in the SdV group) who completed the study. Overall total improvement score was found to be 23.23 and 23.48 for the SdV and dVSSS groups, respectively (p = 0.9245). The percent improvement was 60 and 47 % for the SdV and dVSSS groups respectively, which was a statistically significant difference between the two groups and three tasks. Practicing on the standard da Vinci is comparable to practicing on the da Vinci simulator for acquiring robotic surgical skills. In spite of several potential advantages, the dVSSS arm performed no better than the SdV arm in the final assessment of participant scores. Our findings indicate that both the SdV and dVSSS can be beneficial to residents in improving their robotic surgery skills.

Objective:The objective was to demonstrate that percutaneous nephrolithotomy (PCNL) can be safely performed with a tubeless or totally tubeless drainage technique.Introduction:Standard PCNL includes nephrostomy tube placement designed to drain the kidney and operative tract at the conclusion of the procedure. Modern technique trend is tubeless PCNL and totally tubeless PCNL, which are performed without standard nephrostomy drainage. We aim to reinforce current literature in demonstrating that PCNL can be safely performed using a tubeless technique. With compounded supportive data, we can help generate a trend toward a more cost-effective procedure with improved pain profiles and patient satisfaction, as previously shown with the tubeless technique.Methods:Retrospective analysis of 165 patients who underwent PCNL treatment was performed. Of this group, 127 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 38 patients. Patient's postoperative stone size and burden as well as complication profiles were analyzed. Largest stone size and total stone burden was similar between the groups.Results:Patient characteristics and demographic information were compared and no significant statistical difference was identified between the groups. Complication rates between the groups were compared and no statistical difference was noted. A total of 23 patients had at least one postoperative complication.Conclusion:Tubeless and totally tubeless PCNL demonstrates equivalent outcomes in the properly selected patient group when compared to PCNL performed with a nephrostomy tube. Although this is not the first study to demonstrate this, a large majority of urologists continue standard nephrostomy placement after PCNL. More studies are needed that demonstrate safety of this practice to shift the pendulum of care. Thus, tubeless and totally tubeless PCNL can be performed safely and effectively, which has previously been shown to improve cost, patient pain profiles, and length of hospitalization.