Technology will challenge established procedures

When Stephen Y. Nakada, MD, chairman of the department of urology at the University of Wisconsin, looks to the future, he sees increasing use of robotics, advances in ureteroscope technology that will bring more flexibility and greater clarity to imaging, and the use of computer-driven simulators that will allow both novice and experienced surgeons to learn new skills and hone old ones.

"Broadly speaking, there will be data on margin status, continence rates, and other parameters in laparoscopic and open procedures. This data will allow comparisons between these procedures and traditional open procedures. We can begin to really test whether laparoscopy or robotics match up to open procedures," Dr. Nakada told Urology Times.

Advances in training Laparoscopic and robotic technology is challenging but lends itself to new approaches to education and training. Technological changes in surgical education should be watched carefully, said Dr. Nakada.

"Can we begin to validate surgical simulation as an appropriate training method for laparoscopy and other minimally invasive procedures?" he asked. "Many procedures have become highly technical, and I think that simulation may be the next logical step in surgical training."

Simulation offers the advantage of repetition. The same procedure can be conducted several times in an afternoon to allow skills to be honed quickly. In addition, novel or rare presentations that beginning surgeons may not see in the course of their training can be created on simulators.

During the next 2 to 3 years, urologists should expect to see a number of studies on the advantages and disadvantages of surgical simulation in a wide number of procedures. Institutions such as the University of California at Irvine and the University of Texas Southwestern are already heavily involved in research on surgical simulation, and Dr. Nakada expects their efforts to produce valuable data in the coming years.

Some advances emanate from technology that is common and rather simple. Such is the case with video cameras and tape.

Video mentoring is a process in which a surgeon is videotaped performing laparoscopic tasks. The tape is then reviewed by experts in the field, and the procedures are critiqued with suggestions as to how they can be improved. The surgeon videotapes another procedure incorporating the expert advice, and this tape is then reviewed and critiqued.

"We are beginning to teach people better laparoscopy, teach them to improve their laparoscopic skills without their having to drop their practice for a year and take on a fellowship," Dr. Nakada explained. "Videotape mentoring allows us to give participants personalized critiques of their particular abilities, but this is not a substitute for experience or for having a mentorship relationship with the faculty of a teaching hospital to get these sort of benefits."