Trends in Urology Resident Exposure to Minimally Invasive Surgery for Index Procedures: A Tale of Two Countries

Hoag, Nathan; Mamut, Adiel; Afshar, Kourosh; Amling, Christopher; Mickelson, Jennifer J.; MacNeily, Andrew E.

doi:10.1016/j.jsurg.2012.04.007

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…10,11 The equivalence in major postoperative outcomes may also point to the fact that urology trainees are being exposed to significantly more minimally-invasive surgeries in recent years and thus may be further along the learning curve. 22 In our study, having PGY 3-4 involved as the most senior resident decreased the odds of pLOS in minimally-invasive partial nephrectomies and radical prostatectomies, surgeries that may be more challenging and require a more finely tuned skill set. Alternatively, residents involved at this level may demand less console time and be better adjusted to collaborate with attending surgeons at the assistant level.…”

Section: Discussionmentioning

confidence: 56%

The impact of resident involvement in minimally-invasive urologic oncology procedures

Ruhotina¹,

Dagenais²,

Gandaglia³

et al. 2014

CUAJ

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Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005Files ( -2011, we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. Results: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). Conclusions:Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.

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Section: Discussionmentioning

confidence: 56%

The impact of resident involvement in minimally-invasive urologic oncology procedures

Ruhotina¹,

Dagenais²,

Gandaglia³

et al. 2014

CUAJ

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“…Of particular interest, many urology index cases (donor, radical, and simple nephrectomy, partial nephrectomy, radical prostatectomy, radical cystectomy, adrenalectomy, pyeloplasty, and nephroureterectomy) have substantive overlap with procurement surgeries. 1,2 This could fill the developing void of open surgical experience in many of the cases increasingly being performed with MIS techniques. There are several limitations to our study.…”

Section: Discussionmentioning

confidence: 99%

“…However, exposure to open techniques has become endangered due to shifting practice patterns. 1 With the wide acceptance of minimally invasive surgery (MIS) and the introduction of more conservative treatment options that had in the past required open surgery, the proportion of open surgical cases during Canadian urologic residency has declined. 2 The steady drop in open surgical volume raises concerns about the proficiency among graduating urology residents, yet the effect remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Organ procurement surgery as a means of increasing open surgical experience during urology residency

Hoag

Flannigan

MacNeily

2014

CUAJ

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Introduction: The introduction and advancement of minimally invasive surgery (MIS) has resulted in a reciprocal decline in exposure to open surgery during urology residency training. We propose organ procurement surgery as a potential vehicle to facilitate an increase in open surgical experience among trainees. We define the surgical case volume for organ procurement surgeries currently performed by urology residents in Canada, and determine what capacity exists for expansion.

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“…The most common number of any of these procedures performed by US graduates was zero [11]. A more recent analysis of case-log data from 2004 to 2009 for American urology residents showed no improvement while for Canadian residents there was a slightly improved exposure [24] Exposure to endocrine (adrenal) surgery and mentorship during residency programs are powerful factors that influence residents to pursue careers in endocrine surgery. In a recent survey, fellows performed significantly more endocrine surgery cases during residency than the average graduating chief resident and mentorship was a critical factor in fellows' decisions to pursue endocrine surgery.…”

Section: Literature Regarding Training In Adrenal Surgerymentioning

confidence: 99%

Training in endocrine surgery

Gimm

Barczyński

Mihai

et al. 2019

Langenbecks Arch Surg

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Background/purpose In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. Methods A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. Results For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs.Conclusions Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.

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Trends in Urology Resident Exposure to Minimally Invasive Surgery for Index Procedures: A Tale of Two Countries

Cited by 11 publications

References 12 publications

The impact of resident involvement in minimally-invasive urologic oncology procedures

The impact of resident involvement in minimally-invasive urologic oncology procedures

Organ procurement surgery as a means of increasing open surgical experience during urology residency

Training in endocrine surgery

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