M.S. Khan

Follow‐up of polytetrafluoroethylene arteriovenous fistulae for haemodialysis

The polytetrafluoroethylene (PTFE) arteriovenous fistula allows vascular access for haemodialysis where a primary fistula or brachio‐basilic vein transposition is not possible. We report patency rates and complications associated with these prosthetic grafts.

Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training.

Validation of the bladder control self‐assessment questionnaire (B‐SAQ) in men

To validate the Bladder Control Self‐Assessment Questionnaire (B‐SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men.

891 FACE, CONTENT AND CONSTRUCT VALIDITY OF A VIRTUAL REALITY SIMULATOR FOR ROBOTIC SURGERY (SEP ROBOT)

INTRODUCTION This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool. SUBJECTS AND METHODS The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon’s knot. Thirty participants (18 novices, 12 experts) completed the procedures. RESULTS The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon’s knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants. CONCLUSIONS The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.

Botulinum toxin-A for the treatment of overactive bladder: UK contributions.

Background: Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactive bladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of the world, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures have failed who have symptoms of OAB and or detrusor overactivity (DO). Methods: Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacy lasts for between six and 12 months. Results: It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying the bladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injections are also safe and efficacious. Conclusions: The mechanism of action of the toxin is more complicated than originally thought, and it seems likely that it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment from early experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as a result of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A to treat refractory OAB from UK centres.

El papel de la formación cognitiva en la endourología: un ensayo controlado aleatorizado

INTRODUCTION Cognitive training is an important training modality which allows the user to rehearse a procedure without physically carrying it out. This has led to recent interests to incorporate cognitive training within surgical education but research is currently limited. The use of cognitive training in surgery is not clear-cut and so this study aimed to determine whether, relative to a control condition, the use of cognitive training improves technical surgical skills on a ureteroscopy simulator, and if so whether one cognitive training method is superior. METHODS This prospective, comparative study recruited 59 medical students and randomised them to one of three groups: control- simulation training only (n=20), flashcards cognitive training group (n=20) or mental imagery cognitive training group (n=19). All participants completed three tasks at baseline on the URO Mentor simulator followed by the cognitive intervention if randomised to receive it. Participants then returned to perform an assessment task on the simulator. Outcome measures from the URO Mentor performance report was used for analysis and a quantitative survey was given to all participants to assess usefulness of training received. RESULTS This study showed cognitive training to have minimal effects on technical skills of participants. The mental imagery group had fewer laser misfires in the assessment task when compared to both control and flashcards group (P=.017, P=.036, respectively). The flashcards group rated their preparation to be most useful when compared to control (P=.0125). Other parameters analysed between the groups did not reach statistical significance. Cognitive training was found to be feasible and cost effective when carried out in addition to simulation training. CONCLUSION This study has shown that the role of cognitive training within acquisition of surgical skills is minimal and that no form of cognitive training was superior to another. Further research needs to be done to evaluate other ways of performing cognitive training.

Intravesical Therapy for Refractory Overactive Bladder and Detrusor Overactivity in Adults: Botulinum Toxin-A

It has been 11 years since the first publications on the use of intradetrusor botulinum toxin-A (BTX-A) injections to treat neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI) OnabotulinumtoxinA (Botox®; Allergan, Ltd., Irvine, USA) has recently been approved for use in the bladder of neurogenic patients with spinal cord injury or multiple sclerosis in various parts of the world including the USA and UK. In the near future, it is expected that the FDA in the USA and the MHRA in Europe will approve the use of this toxin in idiopathic detrusor overactivity (IDO). Over the last decade, there has been an explosion of publications on the use of this bladder therapy which is primarily used in patients with symptoms of overactive bladder (OAB) and/or detrusor overactivity (DO) who have failed conservative measures and oral medication with antimuscarinics. This is typically due to poor efficacy with antimuscarinics or poor tolerability due to side effects such as dry mouth, dry eyes, blurred vision and constipation. Initially proof of concept/open labelled studies were conducted, whilst later studies focussed on mechanisms of action. From these studies it became apparent that BTX was not simply working by efferent blockade at the neuromuscular junction, as in skeletal muscle, but was likely to have an effect on sensory nerves. Later publications emerged on technique of administration and evidence from level 1 small randomised blinded placebo-controlled trials in both NDO and IDO. Recently drug sponsored phase II and III double-blind randomised placebo-controlled trials have been conducted in both NDO and IDO. These trials are now published with the exception of the phase III data in IDO at the present time.

Radical cystectomy: how do blood transfusions affect oncological outcomes?

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Volvulus – a rare complication of ileal conduit

Conduit volvulus is a very rare complication of ileal conduit. To date, only seven surgically confirmed cases have been reported. Conduit volvulus is a potentially reversible cause of renal impairment in patients with urinary diversion. The diagnosis depends on accurate radiological evaluation. The length of the bowel to construct the ileal conduit, closure of defects around the conduit and its mesentery and retroperitonealization of ureteroileal anastomosis are the determining factors for such a complication.