Mohammed Shamim Khan

Current status of validation for robotic surgery simulators – a systematic review

Little is known on how best to train the future generation of robotic surgeons. It has been postulated that virtual reality (VR) simulators may aid the progression along the learning curve for this rapidly developing surgical technique within a safe training environment. There are several simulators available on the market, the best known is that developed by Intuitive Surgical Inc. The present study provides the first systematic review of all the trails of the various VR robotic platforms. It explores the evidence supporting the effectiveness of the various platforms for feasibility, reliability, validity, acceptability, educational impact and cost‐effectiveness. This article also highlights the deficiencies and future work required to advance robotic surgical training.

Multimodal management of urolithiasis in renal transplantation.

To report the largest single series of renal transplant patients (adults and children) with urolithiasis, assess the risk factors associated with urolithiasis in renal transplant recipients, and report the outcome of the multimodal management by endourological and open procedures.

Learning curves for urological procedures: a systematic review

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Learning curves for urological procedures

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Measuring the surgical 'learning curve': methods, variables and competency.

To describe how learning curves are measured and what procedural variables are used to establish a ‘learning curve’ (LC). To assess whether LCs are a valuable measure of competency.

Standard versus Tubeless Percutaneous Nephrolithotomy: A Systematic Review

Objective: This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. Methods: The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates. Results: Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status. Discussion: This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.

Ureteric injury: a challenging condition to diagnose and manage.

Although ureteric injury is relatively uncommon, it is a serious event that can result in intra-abdominal sepsis, renal failure, and loss of the ipsilateral renal unit. Most injuries are iatrogenic and remain undiagnosed until the patient presents with symptoms postoperatively. In addition to compromising patient safety, missed ureteric injuries frequently result in litigation. Over the past 20 years, there has been a rapid uptake of laparoscopic and robotic techniques within urology and other surgical specialties. This trend, coupled with increased use of ureteroscopy, has increased the risk of injury to the ureter. The key to diagnosing and managing a ureteric injury is to have a low threshold for suspecting its presence. Diagnosis can be achieved using retrograde pyelography, ureteroscopy, CT, or intravenous urography. Initial management should involve ureteric stent placement or percutaneous nephrostomy drainage. In selected patients, surgical reconstruction might be the optimal approach. Decisions regarding surgical technique (open, laparoscopic, or robotic) are guided by the clinical situation and surgical expertise available.

An overview of the use and implementation of checklists in surgical specialities – A systematic review

INTRODUCTION Surgical procedures present an immense risk to patients, and adverse patient outcomes are frequently due to substandard non-technical skills amongst surgical staff. The implementation of a 19-item Surgical Safety Checklist, developed by the World Health Organization, is being enforced in operating theatres globally. The objective is to systematically analyze published literature to assess the use of the WHO Surgical Safety Checklist and their impact in on patient safety. METHODS An English literature search was carried out using MEDLINE, EMBASE and PsycINFO databases. Relevant information was extracted relating to surgical specialities, compliance with the checklist, effects of checklist use on patient outcomes, and staff perceptions of the checklist. Selection was restricted to articles that used the WHO Surgical Safety Checklist. RESULTS The literature search found 916 potentially relevant articles, which were narrowed down following an abstract review and a full text review. A final total of 16 studies were identified that observed the use of checklists in various surgical specialties; all surgical specialities (n-10), pediatric surgery (n-2), orthopedic surgery (n-2), otorhinolaryngology surgery (n-2). DISCUSSION Surgical checklists have been shown to significantly improve patient outcomes subsequent to surgery, and therefore their use is being widely encouraged and accepted. Continual feedback could be given to maintain high checklist compliance, and thus high patient safety. SUMMARY The recent use of checklists in surgery has shown improvements in patient outcomes post-operatively. A review was conducted to establish the impact of the checklist on different surgical specialities.

INDICATORS FOR RESEARCH PERFORMANCE EVALUATION: AN OVERVIEW

Reuters, Australia , and † Mater Misericordiae Hospital and University College Dublin, Ireland Since the advent of Garfi eld ’ s science citation index in the 1950s [ 1 ] , bibliometrics have been formally used to assess academic productivity and performance [ 2 ] . Although the use of bibliometric studies predates Garfi eld, the need to assess mathematically and statistically the quantity and quality of published work did not arise until the 1960s. This was attributable to the exponential growth in scientifi c publications resulting from the culture of ‘ publish or perish ’ [ 3,4 ] that overwhelmed different scientifi c fi elds, and the need to identify top quality research. With the development of many performance indices over the years, bibliometrics are increasingly becoming a political tool among scientists and policymakers [ 5 ] , to the extent that they can be used in important decisions regarding appointments [ 6 ] , promotions and funding.

Management of ureteropelvic junction obstruction in adults

Ureteropelvic junction obstruction (UPJO) is characterized by impaired flow of urine from the renal pelvis to the ureter. Untreated disease can result in renal impairment making effective management crucial. A combination of CT imaging and diuretic renography is typically used for diagnosis. CT is the investigation of choice for obtaining anatomical information about UPJO and can help to identify potential causes. Diuretic renography is best for providing functional information about UPJO. A variety of open and minimally invasive surgical techniques are available for treatment of UPJO. Traditionally open pyeloplasty has been the standard of care but minimally invasive surgical techniques have become increasingly popular. Endopyelotomy has a lower success rate than other modalities (42–90% depending on the approach), but is associated with reduced pain and shorter convalescence. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%), with the additional advantages of significantly reduced morbidity and shorter convalescence. More long-term outcome data for minimally invasive surgical techniques are awaited.