Objective: To validate robot‐assisted surgery skills acquisition using an augmented reality ( AR )‐based module for urethrovesical anastomosis ( UVA ). Methods: Participants at three institutions were randomised to a H ands‐on S urgical T raining ( HoST ) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR ‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the da V inci S urgical S ystem ( I ntuitive S urgical I nc., S unnyvale, CA , USA ) was assessed using a UVA evaluation score and a G lobal E valuative A ssessment of R obotic S kills ( GEARS ) score. Participants completed the N ational A eronautics and S pace A dministration T ask L oad I ndex ( NASA TLX ) questionnaire for cognitive assessment, as outcome measures. A W ilcoxon rank‐sum test was used to compare outcomes among the groups ( HoST group vs control group and control group vs cross‐over group). Results: A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS . The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. Conclusion: Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.

Objective: The objective of this study is to validate if ex-vivo multispectral photoacoustic (PA) imaging can differentiate between malignant prostate tissue, benign prostatic hyperplasia (BPH), and normal human prostate tissue. Materials and Methods: Institutional Review Board's approval was obtained for this study. A total of 30 patients undergoing prostatectomy for biopsy-confirmed prostate cancer were included in this study with informed consent. Multispectral PA imaging was performed on surgically excised prostate tissue and chromophore images that represent optical absorption of deoxyhemoglobin (dHb), oxyhemoglobin (HbO₂), lipid, and water were reconstructed. After the imaging procedure is completed, malignant prostate, BPH and normal prostate regions were marked by the genitourinary pathologist on histopathology slides and digital images of marked histopathology slides were obtained. The histopathology images were co-registered with chromophore images. Region of interest (ROI) corresponding to malignant prostate, BPH and normal prostate were defined on the chromophore images. Pixel values within each ROI were then averaged to determine mean intensities of dHb, HbO₂, lipid, and water. Results: Our preliminary results show that there is statistically significant difference in mean intensity of dHb (P < 0.0001) and lipid (P = 0.0251) between malignant prostate and normal prostate tissue. There was difference in mean intensity of dHb (P < 0.0001) between malignant prostate and BPH. Sensitivity, specificity, positive predictive value, and negative predictive value of our imaging system were found to be 81.3%, 96.2%, 92.9% and 89.3% respectively. Conclusion: Our preliminary results of ex-vivo human prostate study suggest that multispectral PA imaging can differentiate between malignant prostate, BPH and normal prostate tissue.

Introduction and Objectives: The restriction of resident hours with an increasing focus on patient safety and a reduced caseload has impacted surgical training. A complex and complication prone procedure such as percutaneous nephrolithotomy (PCNL) with a steep learning curve may create an unsafe environment for hands-on resident training. In this study, we validate a high fidelity, inanimate PCNL model within a full-immersion simulation environment. Methods: Anatomically correct models of the human pelvicaliceal system, kidney, and relevant adjacent structures were created using polyvinyl alcohol hydrogels and three-dimensional-printed injection molds. All steps of a PCNL were simulated including percutaneous renal access, nephroscopy, and lithotripsy. Five experts (>100 caseload) and 10 novices (<20 caseload) from both urology (full procedure) and interventional radiology (access only) departments completed the simulation. Face and content validity were calculated using model ratings for similarity to the real procedure and usefulness as a training tool. Differences in performance among groups with various levels of experience using clinically relevant procedural metrics were used to calculate construct validity. Results: The model was determined to have an excellent face and content validity with an average score of 4.5/5.0 and 4.6/5.0, respectively. There were significant differences between novice and expert operative metrics including mean fluoroscopy time, the number of percutaneous access attempts, and number of times the needle was repositioned. Experts achieved better stone clearance with fewer procedural complications. Conclusions: We demonstrated the face, content, and construct validity of an inanimate, full task trainer for PCNL. Construct validity between experts and novices was demonstrated using incorporated procedural metrics, which permitted the accurate assessment of performance. While hands-on training under supervision remains an integral part of any residency, this full-immersion simulation provides a comprehensive tool for surgical skills development and evaluation before hands-on exposure.

Objectives: To determine if patients managed with a cystectomy enhanced recovery pathway ( CERP ) have improved quality of care after radical cystectomy ( RC ), as defined by a decrease in length of hospital stay ( LOS ) without an increase in complications or readmissions compared with those not managed with CERP . Subjects and Methods: The Quality Improvement in Cystectomy Care with Enhanced Recovery ( QUICCER ) study was a non‐randomized quasi‐experimental study. Data were collected between June 2011 and April 2015. The CERP was implemented in July 2013. The primary endpoint was LOS . Secondary endpoints were quality scores, complications and readmissions. Multivariable regression was performed. Propensity score matching was carried out to further simulate randomized clinical trial conditions. A CERP quality composite score was created and evaluated with regard to adherence to CERP elements. Results: The study included 79 patients managed with CERP and 121 who were not managed with CERP . After matching, there were 75 patients in the non‐ CERP group. The LOS was significantly different between the groups: the median LOS was 5 and 8 days for the CERP and non‐ CERP group, respectively ( P < 0.001). Multivariable linear regression showed that any complication was the most significant predictor of total LOS at 90 days after RC . The higher the quality composite score the shorter the LOS ( P < 0.001). There was no association between CERP and a greater number of complications or readmissions. Conclusions: Audited quality measures in the CERP are associated with a reduction in LOS with no increase in readmissions or complications. The CERP is important for the future improvement of peri‐operative care for RC and provides an opportunity to improve the quality of care provided.