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From necessity to defining new standards: the new ORSI Academy Campus aims to advance training standards and opportunities for surgical trainees #OrsiNewCampus

October 1, 2018/8 Comments/by Justin Collins

The sun comes out for the official opening of the new Orsi Academy training campus

Orsi Academy (www.orsi-online.com) is a Belgian centre of surgical innovation and expertise where industry, clinical practitioners and academic partners work together on the improvement of best practices in minimally invasive surgery via training, academic research and technological R&D. Orsi Academy continually strives to form inclusive partnerships to further surgical training and improve patient outcomes.

With expert clinicians from around the world, Orsi Academy has a strong history of pioneering peer-to-peer training driven by collaboration with key opinion leaders in the different medical fields. The trainings are validated through academic research and accredited by different scientific bodies (EAU, NASCE, Ugent, KU Leuven). ORSI Academy continually reports and publishes on validated surgical training and the impact on patient outcomes and published the first validated robotic curriculum.

Within the organisation of Orsi Academy there is a rich history of developing and utilising novel training technologies and developing simulation models for dry and wet-lab training. Our aim is to define optimised surgical techniques and to develop models that reflect these defined objective metrics. Examples of this work include 3D printed models, the Venezolan chicken model for Vesico-urethral anastomosis, the dog cadaver for RARP and VR simulation. An example of a successful product launch in VR simulation is the robotic prostatectomy model on the Simbionix ® system that was developed under the guidance of Orsi Academy training staff. At ORSI Academy the first robotic Curriculum was validated on robotic prostatectomy and is now certified by the European Scientific Society EAU (CC-ERUS). Continuous innovation has helped Orsi Academy maintain a leading market position and the evolved curriculums designed by Orsi Academy are being replicated in training centres of excellence around the world.

Since Orsi Academy’s inception in 2012 it has continued to build on its reputation for training surgeons in new technologies and to continually advance the boundaries of excellence in surgical healthcare. With growing numbers of trainees and courses, capacity became a growing issue and in 2015 ambitious plans were formulated to build a new Orsi campus. The initial plans to rebuild quickly built momentum and planned capacity was further expanded as talks progressed and interest from our supporting partners grew.

The new Orsi Academy, planned for September 2018

In 2016 the design of the new building was finalised. The new Orsi Academy facility would contain four 350m² clusters, each housing four to six fully equipped training labs. Two clusters will be equipped for robotic surgery training, the others will be setup for training in other minimally invasive techniques and would include state-of-the-art imaging technologies. The cutting-edge facility would also include an auditorium with the latest audio-visual technologies, where up to 120 people will be able to attend lectures, watch livestreams of surgeries from around the globe, and contribute to discussions and debates in real-time. Additionally, there would be multiple fully equipped meeting rooms and a modern open office set-up would allow all stakeholders to work efficiently, either alone or in small groups. A new inhouse restaurant was planned that would provide meals with soup bar, salad bar, cold dishes and hot meals available.

In February 2017 work commenced and in August 2018 the dream of creating this training centre of excellence was finally realised.

On the 18^th September Orsi Academy had their official opening of the new campus facilities. The opening ceremony was attended by invited guests, including politicians, representatives of Leuven and Ghent University, surgeons from all over the world and our facilitator for the ceremony a previous Miss Belgium and presenter from Belgian news TV.

Alex Mottrie (CEO), Geert Vandenbrouke (Chairman) and Luc Veramme (COO) present at a press conference from the new 120-seat auditorium

Press look around the new facilities

Some of the guests try out one of the six Da Vinci robots already installed

Describing the benefits of simulation training to the press, to introduce new technologies without compromising patient safety

Industry presents on why they have supported this project

The guests for the opening ceremony begin to arrive and receive their name tags

Mingling in the main entrance hall

Admiring some of the newly installed artwork

Artwork has generously been loaned for both inside and outside the new building

Time to chat with the guests

The celebration party starts

The Orsi Academy training centre has been expanded and upgraded with the support of the European Fund for Regional Development (EFRD), the Flemish Agency of Innovation and Entrepreneurship (VLAIO) and the province of East-Flanders. Additional private funding was provided by the universities of Ghent and Leuven and the medical technology companies Medtronic and Intuitive. Orsi would like to thank industry, the Universities, EU and Flanders funding agencies and all the board for their ongoing support of this educational project. Together we aim to continuously improve standards of training in Europe.

Have you trained at Orsi Academy? If so please post a comment and tell us about your experience and how your career has progressed #OrsiNewCampus

Justin Collins, Medical Director Orsi Academy

The future of Urological Surgical Training

May 14, 2018/13 Comments/by Daron Smith

Dear Urology Trainees and Trainers,

Here are some thoughts stating my reasons for resigning as an educational supervisor – please add your views and help form and drive the debate. Keeping them to yourself, and doing nothing, won’t change anything!

“I have resigned as an official educational supervisor / trainer. This does not mean that I am going to cease to train – far from it: I shall continue to lecture, teach, educate, support, nurture and mentor urological trainees in general, and those who have a subspecialist interest in “EndoLuminal EndoUrology” in particular. But it has become increasingly clear to me (and the senior trainees that I have had over the last decade) that the process of form-filling actually gets in the way of training rather than enhancing it.

As the current round of achieving the appropriate number of Work based assessment (WBA) and Multi-source Feedback (MSF) forms reaches fever pitch, my senior trainee needed to miss the educational opportunity of my monthly super-specialist metabolic stone clinic to have time to complete all his forms. And we both missed half of our stone committee meeting to “sign them off”. The discussions are valuable (we have these continuously); the process is not.

Time is finite, and sadly in inadequately short supply. Part of my role as a consultant is to decide how to spend it most wisely; part of my role as a trainer is to teach my trainee how to do the same. We have reached the conclusion that a form-filling box-ticking exercise, in which regardless of seniority and competency we still have to attest his ability to appropriately prepare and drape a patient for every single case, is not fit for purpose. I would willingly complete these forms ad infinitum if my trainee said they were useful and helped them, but they do not.

So, as stated above, I have decided, until such time as the fixed and rigid process that we work to becomes more flexible and adaptable to the specific and individual needs of trainees, that I can no longer waste their time (or mine) adhering to a rule just because it is a rule. I reiterate my second line to emphasise that this does not mean I am going to discontinue to train; it simply means that I am going to discontinue to complete the forms that are used as evidence that I have. I think the “final product” of a more senior, technically adept and consultant-ready surgeon that leaves the unit at the end of the year, compared with the one that arrived at the start of it (as judged by an independent expert colleague) would provide far better evidence of that than any number of electronic forms.”

It would be particularly good to hear comments from trainees because this is not just for your immediate future, but as the soon-to-be trainers of the future. So yours are the key opinions needed to get this right!

Daron Smith, Consultant Urological Surgeon, Endoluminal Endourology Unit, UCLH.
@endoluminalendo

The value of fresh cadaveric dissection

May 29, 2014/7 Comments/by Fairleigh Reeves

I am very lucky to have had the opportunity recently to undertake research in the fresh cadaver lab at University of Maryland School of Medicine, Baltimore.

The availability and quality of fresh cadaveric specimens at the School of Medicine was outstanding. The School’s Anatomical Services Division is also the site of the Maryland State Anatomy Board, and processes over 2000 cadavers per year. No after death donations by family members are accepted. By word of mouth, public awareness of the research and education achievements of the lab means that there is no shortage of people volunteering to donate their body. Minimal processing time allows access to specimens that are truly fresh. The cadavers I used were arterially flushed with a broad-spectrum disinfecting solution, and stored chilled at 2 degrees Celsius between uses. This technique allowed me to work with the same fresh specimen daily for several weeks. My previous experience of cadaveric dissection was with formalin fixed specimens. Although this offers satisfactory opportunity to dissect and appreciate gross anatomical structures, discrete tissue planes are lost, which changes one’s sense of “operating”. Tissue becomes inflexible and dissecting small branches of nerves, such as my task was, becomes extremely challenging. Dissection of fresh cadavers is remarkably similar to operating on a live person. This facilitated my dissection from a research perspective, and also allowed me (as a surgical trainee) to improve my understanding of surgical planes and how to work with tissue.

The labs in use (photo courtesy of Ronn Wade)

Learning in the lab also occurs in a less formalised way. One afternoon, I found myself working alongside an ENT surgeon performing a complex facial reconstruction. He explained that when he has scheduled upcoming operations with which he has limited experience, he undertakes a mock procedure prior to the case. What an incredible opportunity to improve patient care.

In an era where surgical training is heavily logbook-based, it can be challenging to ensure all trainees get comparable exposure. Fresh cadaver labs may offer one way to bridge the gap during training, as well as consolidate skills after fellowship.

Research in the anatomy lab can also lead to advancements in surgery. University of Maryland Medical Centre was one of the first centres in the world to perform a full-face transplant. Performance of mock procedures on fresh cadavers was integral to the development and refinement of the procedure. This is a clear example of how fresh cadaver labs can directly contribute to improving surgical care.

Unfortunately, it seems that anatomical education in many institutions is moving away from cadaver use. My experience in Baltimore reminded me that fresh cadaveric labs are invaluable in surgical training and research. I would like to acknowledge the generous gift that many people make in donating their body to medical education and research. I am very grateful for Professor Anthony Costello and Dr James Borin facilitating my visit to University of Maryland School of Medicine, and to Ronn Wade and his team for generously welcoming me in the anatomy lab.

I implore the surgical community to advocate for the protection of existing labs, and development of new fresh cadaver labs.

Fairleigh Reeves
Urology Research Fellow, The Royal Melbourne Hospital, Australia
Twitter @DrFairleighR

A word of advice

April 30, 2014/2 Comments/by Simon van Rij

I saw a patient recently who presented with a number of different symptoms on the background of a complex past medical history. I rang my senior who quoted me these words,

“Sometimes the questions are complicated but the answers are simple”

I’ll tell you where he got that quote from later

One CT scan later we had our diagnosis but it got me thinking about the advice we receive from senior colleagues.

During our formal urology training we are mentored by urologists who at times impart advice to enable us to become better. The words spoken in a timely manner or often a repeated manner can become etched into a young surgeon’s mind.

Now for 2 stories:

Early in my surgical training I sat dejected in the professor’s office. A life threatening complication had occurred in one of our team’s patients after major open surgery. I was ready to throw the towel in, to no longer perform large operations to therefore avoid complications. I would be safe if I only ever performed minor procedures for the rest of my career.

“There are no such things as small surgeries only small surgeons”.

Spoken by one who had been there and done that and come out the other side. Years later near the end of my training I was lucky to operate again with this surgeon and thanked him for his words of advice. However as often happens in a moment of stress, similar I imagine to the moment a diehard fan meets their rock star idol, I proudly repeated back his words only for him to correct me again, as I had spoken them in the wrong order.

Story two took place after a Saturday ward round over coffee. Real coffee – (flat whites as we call them in New Zealand) in the hospital café where there was time to talk – no theatre list, no private clinic to rush off to.

“The cheapest mistake you will ever make is the complications of others”

I was implored to chase after the complications that happen to all patients in the hospital. So as to learn as much from them and how they were managed to avoid it in my own practice in the future. It challenged me to investigate, to read, to apply knowledge, to sit up in the monthly audit and to ask questions of why things happen.

3 statements have helped guide my surgical training. Said in isolation they mean little and could even sound cliché. However coming from a respected mentor at an appropriate time in a personalised fashion they have proved of immense value. And the further beauty is they will have repeated value as I attempt to pass them on in the future. Which brings me back to the opening statement and the whereabouts of its origins. Indeed those words were not my consultants own but rather that of another doctor. Dr. Seuss to be exact and it only goes to show that advice is often where you least expect it.

(On further research I wonder if this is where he actually got the statement from

Advice’s You Need to Know About Hair Loss, According to Dermatologists

SAKSIT SRISUKSAI / EYEEMGETTY IMAGES

If you’ve noticed patchy or thinning spots on your scalp or a surplus of hair strands on your hairbrush or in the shower, you’re not alone. More than half of all women will experience noticeable hair loss, according to the Cleveland Clinic. In order to put a stop to shedding, though, you have to figure out the root of the problem. “Hair loss is not a diagnosis,” says Yolanda Lenzy, M.D., M.P.H.,board-certified dermatologist and licensed cosmetologist in Chicopee, Massachusetts. “Hair loss is a symptom. Once you get a specific diagnosis, then you can know the causes associated with that diagnosis.” You can check some of the best dermatologist melbourne on doctor to you site.

For starters, know that the term “alopecia” refers to all kinds of hair loss. There are two main types of alopecia, and then a variety of forms of hair loss within those two categories. In cases of non-scarring or temporary hair loss, the missing hair will eventually grow back. With scarring or permanent hair loss, permanent damage is done to the hair follicles so they won’t grow back. “With scarring hair loss, the goal is not for it to grow back, but to stop the progression,” says Dr. Lenzy. Below, are seven different kinds of alopecia —knowing which one you’re suffering from will help determine the proper treatment.

GETTY IMAGES

Non-scarring (Reversible) Forms of Hair Loss

Androgenetic alopecia

When people talk about male or female pattern hair loss — typically a receding hair line in men or thinning at the crown in women — that’s androgenetic alopecia. It’s the most common form of hair loss among all people. In fact, research shows that more than 50% of women will develop androgenetic alopecia by the age of 80. “It can come from either side of the family in men or women, skip a generation, and start earlier in the next generation that the one before it,” says dermatologist Carolyn Goh, M.D., Health Sciences Assistant Clinical Professor at the David Geffen School of Medicine and Director of the Hair and Scalp Disorder Clinic at UCLA. “However, some people have pattern hair loss without a family history of it.” While some women start showing signs of androgenetic alopecia in their teenage years, others won’t experience it until their 50s or 60s. “When nearing menopause, the decrease of estrogen means you have unopposed testosterone,” says Dr. Lenzy. “That elevated testosterone can convert to a hormone called dihydrotestosterone (DHT), which contributes to the thinning of the hair follicles — the follicles actually get smaller in this particular form of hair loss.”. If you have straight hair then consister a permed texture you should buy kinky straight hair.

MORE FROM GOOD HOUSEKEEPING

Telogen effluvium

Telogen effluvium is just a fancy name for excessive hair shedding — an annoyance that many people will experience at some point in their life. “A common cause is stress, usually meaning major life stressors or physical stressors like surgery, medication (including over the counter ones and supplements), weight loss, or a death in the family, to name a few,” says Dr. Goh. “It usually starts three to six months after a stressor and then lasts for three to six months.” Hypothyroidism and iron deficiency can also trigger telogen effluvium. “The beautiful thing about it is 70% of your hair strands are still in the anagen or growing phase,” adds Dr. Lenzy. “Because the hair follicles work in a cycle, you won’t go bald.”

Alopecia areata

This type of hair loss affects about 2% of people and usually appears as round smooth circles anywhere on the head without any redness, itching, or pain. “Alopecia areata is thought to be caused by an autoimmune process,” says Dr. Lenzy. “The body’s immune system makes some mistakes and produces T cells that attack hair follicles.”

Traction alopecia

Thinning and bald patches at the temples or where hair is frequently pulled tight can indicate traction alopecia. “This very common form of hair loss is caused by haircare and hairstyle practices — practices which place excessive tension or weight on the follicles like braids, ponytails, hair extensions, or locs.”

Scarring (Permanent) Forms of Hair Loss

Central centrifugal cicatricial alopecia (CCCA)

“Central centrifugal cicatricial alopecia tends to start on the top of the head with breakage and thinning, and often with some tenderness of the scalp,” says Dr. Goh. “It gradually spreads outward and can cause permanent hair loss.” CCCA is especially common among Black women. “Some recent studies have found that about 25% of people with this form of hair loss have a genetic mutation in one of the proteins that’s responsible for the formation of the hair follicle,” says Dr. Lenzy. On top of that, she notes that the same haircare practices that create tension and cause traction alopecia also contribute to CCCA.

Article of the week: Behind the curve: residents’ access to RAL is poor in Europe

December 11, 2013/2 Comments/by admin Z.9

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by prominent members of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Dr. Furriel discussing his paper.

If you only have time to read one article this week, it should be this one.

Training of European urology residents in laparoscopy: results of a pan-European survey

Frederico T.G. Furriel, Maria P. Laguna*, Arnaldo J.C. Figueiredo, Pedro T.C. Nunes and Jens J. Rassweiler^†

Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal, *Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and ^†Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

Read the full article

OBJECTIVE

• To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments.

MATERIALS AND METHODS

• A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012.

• Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated.

• Data was analysed with descriptive statistics.

RESULTS

• In all, 219 European urology residents answered the survey.

• Conventional laparoscopy was available in 74% of the respondents’ departments, while robotic surgery was available in 17% of the departments.

• Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least ‘satisfactory’; 32% of the residents did not attend any course or fellowship on laparoscopy.

• Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory.

• The motivation to perform laparoscopy was rated as ‘high’ or ‘very high’ by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy.

CONCLUSIONS

• Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor.

• Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.

Read Previous Articles of the Week

Editorial: Minimally invasive surgical training: do we need new standards?

December 11, 2013/by Antonio Galfano

The pan-European survey conducted by Furriel et al. [1] in this issue of BJUI is a timely address of a hot topic in urology.

More than 20 years have passed since the first laparoscopic nephrectomy was performed by Clayman et al. [2] in 1991, and now all urological major interventions have been performed with one or more different minimally invasive techniques (standard, single-site or robot-assisted laparoscopy); some of them have passed the judgment of time becoming ‘gold standard’ treatments, while others are still under evaluation. Specifically, the European Association of Urology (EAU) guidelines recommend laparoscopic radical nephrectomy as the ‘standard of care’ over open surgery, report favorable outcomes for robot-assisted laparoscopic radical prostatectomy, and propose as optional treatments laparoscopic or robot-assisted partial nephrectomy and radical cystectomy [3].

Obviously, this surgical revolution brings two major new issues: (i) Starting from academic and training centres, hundreds of Urology Departments throughout Europe need to update their surgical knowledge and expertise, making senior urologists perform up-to-date procedures; (ii) Residents and young urologists require adequate and possibly standardised training in minimally invasive surgery, learning at least the basic laparoscopic skills. The study by Furriel et al. [1] correctly highlights both problems.

First, according to the survey, penetration of laparoscopy in the most important urological training centres is unexpectedly low. In fact, more than one out of four centers (26%) do not perform minimally invasive surgery, even for the ‘standards of care’, such as laparoscopic radical nephrectomy. Moreover, as the survey was conducted specifically on the topic of minimally invasive surgery, it is probable that unexposed residents were less interested in responding, making the data of penetration probably even worse than reported. This fact reflects a serious problem present in most training centres. While previously surgery slowly evolved, laparoscopy and technology brought sudden innovations, putting several senior urologists ‘out of the game’. Hence, today, training is needed not only for residents, but also for consultants. In the meantime, it is important that residents are trained in centres were minimally invasive surgery is already widely available. In this perspective, European educational authorities should endeavour to certificate the residents’ training centres, for example on the basis of adherence to EAU guidelines. Academic or non-academic training centres not adherent to guidelines (and thus not performing minimally invasive surgery) should therefore be deprived of residents.

Secondly, training residents in minimally invasive surgery can be approached in different ways, from low-cost self-made dry laboratories to expensive virtual reality or robotic three-dimensional simulators. According to the survey, >40% of centres have no training facilities available. It has been shown that self-built, cheap, dry laboratories are as efficient in training as the industrial ones [4], so that it is not a matter of costs but a matter of interest. We strongly believe that watching surgical videos, observing live surgeries and using (low-cost or not) dry laboratories are fundamental steps in acquiring the basic skills in laparoscopy, while the modular training proposed by Stolzenburg et al. [5] for laparoscopic radical prostatectomy is the best live training model and can be exported to other kinds of surgery, such as radical or partial nephrectomy. In the centres where robot-assisted surgery is available, working as a table-side assistant is another good way to acquire laparoscopic skills.

A great debate is currently ongoing about credentialing in minimally invasive surgery training [6]. Pragmatically, when the European training centres are certificated for adherence to the EAU guidelines, there will be no need for a specific credentialing in laparoscopic skills, because it will be included in the standard training path, together with endoscopic and open surgery.

In conclusion, the survey by Furriel et al. [1] shows that times are changed: the old axiom ‘big cut, big surgeon’ is not valid anymore. The emerging urological generations know it, and ask to be adequately trained. Training centres must evolve, because in 2013 minimally invasive surgery has formally to be considered as part of the standard urological armoury.

Antonio Galfano and Aldo Massimo Bocciardi
Department of Urology, Ospedale Niguarda Ca’ Granda, Milan, Italy

Read the full article

References

Furriel F, Laguna MP, Figueiredo A, Nunes P, Rassweiler JJ. Training of European urology residents in laparoscopy: results of a pan-European survey. BJU Int 2013; 112: 1223–1228
Clayman RV, Kavoussi LR, Soper NJ et al. Laparoscopic nephrectomy. N Engl J Med 1991; 324: 1370–1371
EAU Guidelines, edition presented at the 28th EAU Annual Congress, Milan 2013. ISBN 978-90-79754-71-7. EAU Guidelines Office, Arnhem, The Netherlands. Available at: https://www.uroweb.org/guidelines/online-guidelines/. Accessed September 2013
Beatty JD. How to build an inexpensive laparoscopic webcam-based trainer. BJU Int 2005; 96: 679–682
Stolzenburg JU, Schwaibold H, Bhanot SM et al. Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 2005; 96: 1022–1027
Lee JY, Mucksavage P, Sundaram CP, McDougall EM. Best practices for robotic surgery training and credentialing. J Urol 2011;185: 1191–1197

Video: How do urology residents rate their laparoscopic experience?

December 11, 2013/by admin Z.9

Training of European urology residents in laparoscopy: results of a pan-European survey

Frederico T.G. Furriel, Maria P. Laguna*, Arnaldo J.C. Figueiredo, Pedro T.C. Nunes and Jens J. Rassweiler^†

Read the full article

OBJECTIVE

• To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments.

MATERIALS AND METHODS

• A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012.

• Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated.

• Data was analysed with descriptive statistics.

RESULTS

• In all, 219 European urology residents answered the survey.

• Conventional laparoscopy was available in 74% of the respondents’ departments, while robotic surgery was available in 17% of the departments.

• Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory.

• The motivation to perform laparoscopy was rated as ‘high’ or ‘very high’ by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy.

CONCLUSIONS

• Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.