Transformations of many aspects of surgery have provided a potentially fertile ground for the implementation of surgical simulators in the medical mainstream. The expansion of minimally invasive diagnostic and therapeutic modalities, increasing healthcare demands, fiscal constraints, and sensitivity to medicolegal considerations limit resident instruction and practical experience in the operating room. Furthermore, the need for objective, structured assessments of surgical residents during training and the requirement for physicians to gain and maintain certification demand that innovative solutions be sought. Surgical simulators are poised to deliver broad-based training experiences to trainees of all levels. In urology, simulation has been centered on endourologic procedures, namely ureteroscopy and cystoscopy. In this paper, various models of simulation developed for ureteroscopy and cystoscopy in urology are reviewed, with a brief description of each model, its benefits and disadvantages, and current research surrounding each simulation model.
Adrenal insufficiency is a disorder characterized by hypoactive adrenal glands resulting in insufficient production of the hormones cortisol and aldosterone by the adrenal cortex. This disorder may develop as a primary failure of the adrenal cortex or be secondary to an abnormality of the hypothalamic-pituitary axis. Patients with adrenal insufficiency often are asymptomatic or they may present with fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin. The presentation of adrenal insufficiency varies dramatically and poses a major diagnostic dilemma. This review focuses on the diagnosis and treatment of primary and secondary adrenal insufficiency.
Background and objective Open radical prostatectomy (ORP) is the standard approach for the surgical management of localized prostate cancer. The steep learning curve for laparoscopic prostatectomy poses a challenge for surgeons with minimal laparoscopic experience. As robotic-assisted surgery becomes more prevalent in the urologic community, there appears to be an increasing interest in robotic-assisted radical prostatectomy (RARP) among urologists throughout the United States. We report on the impact of robotics on practice patterns in the treatment of localized prostate cancer at a single institution. Methods A retrospective review was conducted of radical prostatectomies performed between January 2000 and December 2006 at Hackensack University Medical Center (Hackensack, N.J.). Over this time period, our medical center acquired four da Vinci™ Surgical Systems. The trends for open and robotic-assisted prostatectomies were analyzed.Results Over a 7-year period (2000–2006), a total of 1252 radical prostatectomies were performed by 17 urologists: 469 (37%) ORPs and 783 (63%) RARPs. The total number of prostatectomies increased annually during this time period. The robotic-assisted procedure was predominantly performed by three (18%) urologists from 2001–2003, seven (41%) in 2004, nine (53%) in 2005, and 11 (65%) in 2006. As more urologists became trained in robotic-assisted surgery, the trend gradually shifted towards robotic-assisted prostatectomy. In 2001, only 9.6% of all radical prostatectomies at our institution were performed with robotic assistance; in 2006, this had risen to 92.8%.Conclusion The acquisition of the da Vinci™ Surgical System has allowed robotic-assisted surgery to be an available alternative to open surgery at a single institution. The implementation of robotic technology has led to the gradual adoption of robotic-assisted radical prostatectomy by many of the urologists that surgically treat prostate cancer. As a result, the percentage of open prostatectomies has steadily decreased over time, while trends in robotic-assisted prostatectomies have increased. The impact of robotics also appears to have had an influential effect on the total number of prostatectomies performed annually.
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