Akshay Sood1, Peter McCulloch2, Philipp Dahm3, Rajesh Ahlawat4, Wooju Jeong5, Mahendra Bhandari5, Mani Menon5. 1. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA. Electronic address: asood1@hfhs.org. 2. Nuffield Department of Surgery, University of Oxford, Oxford, UK. 3. Department of Urology, University of Minnesota, Minneapolis, MN, USA. 4. Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India. 5. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Abstract
INTRODUCTION: Innovation is a hallmark of surgical practice. It is generally accepted that a new procedure will undergo technical changes during its evolution; however, quantitative accounts of the process are limited. METHODS: Multiple groups, including our own, have recently described a minimally-invasive approach to conventional kidney transplantation (KT) operation. Unique to our experience is a structured development of the technique within the confines of a safe surgical innovation framework - the IDEAL framework (idea, development, exploration, assessment, long-term monitoring; stages 0-4). We here provide a first-hand narrative of the progress of robotic KT operation from preclinical trial to clinical application. RESULTS: Overall, 54 patients underwent robotic KT with regional hypothermia successfully. Major technical changes including selection of optimal patient position (flank vs. lithotomy), robotic instrumentation, vascular occlusion method (bulldog vs. tourniquet) and suture material (prolene vs. GoreTex) occurred early during the procedure development (IDEAL stage 0, preclinical). Minor technical changes such as utilization of the aortic punch for arteriotomy (case 3), use of barbed suture during ureteroneocystostomy (case 6) and extraperitonealization of the graft kidney (case 6) that increased the efficiency and safety of the procedure continued throughout procedure development (IDEAL stages 1-2, clinical stages). CONCLUSIONS: We demonstrate that a surgical technique evolves continually; although, the majority of technical alterations occur early in the life-cycle of the procedure. Development of a new technique within the confines a structured surgical innovation framework allows for evidence based progression of the technique and may minimize the risk of harm to the patient.
INTRODUCTION: Innovation is a hallmark of surgical practice. It is generally accepted that a new procedure will undergo technical changes during its evolution; however, quantitative accounts of the process are limited. METHODS: Multiple groups, including our own, have recently described a minimally-invasive approach to conventional kidney transplantation (KT) operation. Unique to our experience is a structured development of the technique within the confines of a safe surgical innovation framework - the IDEAL framework (idea, development, exploration, assessment, long-term monitoring; stages 0-4). We here provide a first-hand narrative of the progress of robotic KT operation from preclinical trial to clinical application. RESULTS: Overall, 54 patients underwent robotic KT with regional hypothermia successfully. Major technical changes including selection of optimal patient position (flank vs. lithotomy), robotic instrumentation, vascular occlusion method (bulldog vs. tourniquet) and suture material (prolene vs. GoreTex) occurred early during the procedure development (IDEAL stage 0, preclinical). Minor technical changes such as utilization of the aortic punch for arteriotomy (case 3), use of barbed suture during ureteroneocystostomy (case 6) and extraperitonealization of the graft kidney (case 6) that increased the efficiency and safety of the procedure continued throughout procedure development (IDEAL stages 1-2, clinical stages). CONCLUSIONS: We demonstrate that a surgical technique evolves continually; although, the majority of technical alterations occur early in the life-cycle of the procedure. Development of a new technique within the confines a structured surgical innovation framework allows for evidence based progression of the technique and may minimize the risk of harm to the patient.
Authors: Alberto Breda; Angelo Territo; Lluis Gausa; Oscar Rodríguez-Faba; Jorge Caffaratti; Javier Ponce de León; Lluis Guirado; Carme Facundo; Marco Guazzieri; Andrea Guttilla; Humberto Villavicencio Journal: World J Urol Date: 2017-02-22 Impact factor: 4.226
Authors: Kishore Thekke Adiyat; Kumar K Vinod; Raveendran Vishnu; M K Ramaprasad; Vavullipathy N Unni; Roy P John Journal: J Robot Surg Date: 2018-02-01