Young Urologists/Residents Corner EUSP Clinical Visit Gaining skills at Madrid’s University Hospital La Paz Dr. Bilal Gunaydin Istanbul Medeniyet University Goztepe Training and Research Hospital Dept. of Urology Istanbul (TR) bilalgun@ hotmail.com
From 10 December 2016 to 10 March this year, I was fortunate to be the recipient of a Clinical Visit scholarship from the European Urological Scholarship Programme (EUSP). The EUSP host centre was the University Hospital La Paz, a public hospital located in the northern outskirts of Madrid. Since the inauguration of the General Hospital in July 1964, it has now become the well-known hospital complex consisting of 17 buildings and four large hospitals, namely: General Hospital, Maternal Hospital, Hospital Infantil and the Hospital of Traumatology and Rehabilitation. It also offers specialised healthcare not only to local patients from across Spain but also those coming from other countries. High volume center La Paz is a high volume healthcare center. In 2009, the La Paz University Hospital has hosted more than 50,500 patients in its hospitalisation facilities, and had more than 220,000 emergency consultations. Approximately one million outpatient consultations and 42,890 surgical procedures have been performed in its facilities, including complex surgical procedures such as organ transplantations. To meet this volume, La Paz University Hospital employs a team of almost 7,000 professionals on 180,000 square meters of modern facilities.
Urology Department The chief of the Urology Department is Dr. Luis Martinez-Piñeiro Lorenzo, an excellent urologist. Although specialised in uro-oncology and reconstructive urology, he also performs other urologic procedures. Since my interest is in renal transplantation and endourology, La Paz urology clinic was an ideal centre, thanks to the European Urological Scholarship Programme ( EUSP). On my first day, I met Dr. Juan Gomez Rivas and Prof. Fermín R. de Bethencourt, who both briefed me on the daily tasks and routines of the department. Daily morning meetings begin at 8 a.m. with clinical discussion of the hospitalised patients, urgent cases and patients scheduled for surgical operations the next day. After the meeting, I proceeded to the operation room to observe all of the cases. La Paz Urology clinic has three operation rooms, with one room for uro-oncology, an ideal set-up for me since I had the opportunity to see a lot of procedures in endourology, uro-oncology and renal transplantations. My special thanks to Dr. Fermin R de Bethencourt, Dr. Luis Martinez-Piñeiro, Dr. Alfredo Aguilera, Dr. Alonso Dorrego, Dr. Cristina de Castro, Dr. Ramón Cansino, Dr. Jose Ramón Perez-Carral, Dr. Juan Gomez Rivas and Dr. Mario Alvarez Maestro for their experienced mentorship. Madrid has been memorable and I had special dinners with Dr. Mario Alvarez Maestro, Dr. Juan Gomez Rivas and the residents with whom I developed good friendships. Certainly, I will use the experience and insights I learned in Madrid in my own university. My heartfelt thanks to all the staff of the Department of Urology at La Paz University Hospital, my mentor Dr. Selçuk Sılay and the EUSP for giving me this priceless opportunity!
Impressions of my wonderful fellowship in University Hospital La Paz
Surgical training at Aalst, Belgium Turkish surgeon benefits from excellent robot-assisted surgical training There are four DaVinci Robotic Surgery systems available at ORSI Academy, including three Si systems and one Xi. Trainees have the opportunity to work in wet and dry laboratories. Each system has a simulator and in three systems, there is a possibility to work on a dual console. Besides the theoretical and practical knowledge, trainees also work on living animals, cadavers and training boxes for them to fully adapt to the system. At the end of the course, successful participants are issued a certificate from the NASCE-accredited training centre ORSI Academy.
Dr. Fatih Özkaya Erzurum Regional Training and Research Hospital Dept. of Urology Erzurum (TR)
drfatihm@gmail.com Live animal model surgery with dual console at ORSI
The acceptance of robotic surgery as a minimally invasive procedure has increased due to the perceived comfort experienced by patients and physicians. Robot-assisted surgery, used especially in treating urological diseases such as prostate and kidney cancers and uretero-pelvic junction obstruction, is becoming more and more frequent in other surgical fields. There are, however, obstacles to robot-assisted surgery such as expensive equipment (limited to expert centres), certification and a learning curve for surgeons.
O.L.V. Vattikuti Robotic Surgery Institute (ORSI)
32
European Urology Today
As a young urologist, I trained hard in a six-week programme with Prof. Dr. Alex Mottrie, professor in the Urology Department of the OLV Hospital in Aalst-Belgium, chairman of the EAU Robotic Urology Section (ERUS) and head of the ORSI Academy. Training programme The programme consists of clinical work in the operating theatres on weekdays but mostly on Tuesday and Thursday. We received intensive hands-on training in ORSI Academy and the hospital and ORSI staff were very helpful. The operations begin at about 8 o’clock and our daily routine tasks end when all cases were finalised.
Pelvic lymph node dissection on a fresh dog cadaver at ORSI
One-on-one mentorship One of the key aims of the programme is for participants to engage one-on-one in the cases, train hard using the simulator for them to hone their skills with a 3D environment. Staff members in Aalst and at the institute are very helpful, and Prof. Mottrie as a mentor provides experienced insights. Besides the case discussions and sharing tips and tricks, he also teaches that learning does not happen only by watching. Although my training programme was limited to a short period, I highly recommend this robotic
training and I would suggest a longer period, for example at least three months. This programme provides not only specialised training, but also practical experience and friends. The training programme has seen increasing numbers of participants, and I am sure that for those who have participated and learned in Aalst, the mentorship they have received has contributed significantly in the improvement of to their surgical skills.
There are three DaVinci robotic surgery systems, (two Si and one Xi systems) used in the Urology Department. Different robotic procedures, mainly radical prostatectomy operations as well as cystectomy, partial cystectomy, partial nephrectomy, radical nephrectomy, pyeloplasty, lymphadenectomy, sacrocolpopexy and ureteral re-implantation are being performed. With a dual console and 3D screens, trainees have the opportunity to monitor, observe and work with the surgeon. For trainees, active participation is important since this will hone their skills and provides practical insights regarding the procedures. Prof. Dr. Alex Mottrie and the training fellows March/May 2017