Training Postgraduate Urologists in Laparoscopic Surgery: The Current Challenge

Shalhav, Arieh L.; Dabagia, Mark D.; Wagner, Timothy D.; Koch, Michaël; Lingeman, James E.

doi:10.1016/s0022-5347(05)65108-7

Cited by 73 publications

(35 citation statements)

References 2 publications

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“…40,43 In view of these barriers, several mentored and simulator-based training programs consequently emerged to facilitate skill transfer from experienced to laparoscopy-naive urologists. [44][45][46] The high percentage of provider-attributable variance also may reflect unmeasured differences in practice setting (and consequent access to information) among surgeons in our sample. That is, most providers make conclusive decisions about innovations based on interactions with local peer adopters rather than on scientific research or mass-media channels.…”

Section: Discussionmentioning

confidence: 97%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 97%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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“…43 More vigorous training has been shown to expedite the learning process, transfer technical skill at a higher rate, and lead to higher retention over the longterm. 39,[44][45][46] To promote the advancement of patient care through new surgical technologies while also ensuring patient safety, the American College of Surgeons has established multiple Accredited Education Institutes to facilitate transfer of surgical innovation to practicing surgeons, [47][48][49] similar programs may be beneficial for urologists and other surgical oncologists who are faced with the challenge of adopting complex new technologies.…”

Section: Discussionmentioning

confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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BACKGROUND:Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of 4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P ¼ .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;117:4184-93.

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“…Shalhav and colleagues (5) found that an intensive 1 : 1 mentor : trainee experience at the postgraduate level, while challenging to accomplish, did improve the likelihood of the training surgeon assimilating this surgical technique into his/her clinical practice. In their study, both the urologists entered into the programme went on to incorporate laparoscopy into their surgical practice immediately following the training programme.…”

Section: Discussionmentioning

confidence: 99%

Short-term impact of a robot-assisted laparoscopic prostatectomy ‘mini-residency’ experience on postgraduate urologists' practice patterns

McDougall

Corica

Chou

et al. 2006

Int. J. Med. Robotics Comput. Assist. Surg.

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A 5 day intensive RALP M-R course seems to encourage postgraduate urologists, already familiar with laparoscopy, to successfully incorporate robotic surgery into their practice. The take rate, or the percentage of participants performing robotic-assisted surgery within 14 months after M-R, was 95%. Continued follow-up will ultimately determine the long-term effectiveness of this 1 week intensive training programme for postgraduate urologists.

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Training Postgraduate Urologists in Laparoscopic Surgery: The Current Challenge

Cited by 73 publications

References 2 publications

Diffusion of surgical innovation among patients with kidney cancer

Diffusion of surgical innovation among patients with kidney cancer

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Short-term impact of a robot-assisted laparoscopic prostatectomy ‘mini-residency’ experience on postgraduate urologists' practice patterns

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