Tony Costello

OBJECTIVE: To conduct a multi-institutional validation of a high-fidelity, perfused, inanimate, simulation platform for robot-assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards. MATERIALS AND METHODS: Using a combination of three-dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2-cm, upper-pole renal tumour (RENAL nephrometry score 7×). 3D-printed casts designed from the patient's imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty-seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation. RESULTS: Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank-sum (continuous variables) and parametric chi-squared (categorical variables) tests. Pearson and point-biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post-simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness. RESULTS: Expert ratings demonstrated the model's superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra-operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS. CONCLUSIONS: This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure-specific performance metrics.

For the Translational Science stream, moderated poster session will be included as part of the main program on the afternoons of Wednesday 7th and Thursday 8th August 2013. For the Nursing & Allied Health Streams, there will be moderated poster viewing on Wednesday 7th August from 1730–1830, please prepare a four minute presentation and attend your poster between these times. A roving audience will listen to your four minute presentation beside your poster during this time. Wednesday evening Poster Viewing & Cocktail Reception: 1730–1900. This popular session returns this year and allows delegates and industry to mix over refreshments while enjoying casual poster viewing. In addition, the top posters from each category will be announced and will be awarded their cash prizes (generously sponsored by Ipsen Pharmaceuticals). Professor Tony Costello President, Prostate Cancer World Congress Associate Professor Declan Murphy Convenor, Clinical Urology

BACKGROUND: Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts. METHODS: A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building. RESULTS: 12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS. CONCLUSIONS: The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.

BACKGROUND: Robotic surgery is an increasingly common component of surgical practice, yet it remains underrepresented in medical student education. While student interest in robotic surgery is high, their exposure is often informal and incidental. OBJECTIVE: To map the existing literature on robotic surgery curricula developed for medical students and to evaluate the extent to which these curricula align with Kern's six-step framework for curriculum development. METHODS: A scoping review was conducted using PRISMA-ScR guidelines. MEDLINE, EMBASE, and Cochrane databases were searched. Studies were included that focused on medical students and addressed one or more of Kern's six curriculum development steps. Dual independent screening and consensus coding were used. Data were extracted and mapped to Kern's framework. RESULTS: Twenty-one studies were included, primarily small, single-institution pilots featuring the da Vinci surgical system. Most described technical skills training delivered via simulation. Few studies defined learning objectives and none addressed non-technical skills such as communication and teamwork. Implementation was limited with no evidence of long-term evaluation or curricula integration. CONCLUSION: While robotic surgery curricula for medical students are feasible and valued, they remain in early stages of development. There is a need for structured, scalable and educationally grounded curricula that introduce foundational knowledge and support student readiness for technology-integrated surgical practice.