Midcareer Mentorship in Reconstructive Pediatric Urology MIS: Program description and outcome analysis
Ashhad Ali Khan, M.ch1, Walid A. Farhat, MD , FRCSC , FACS2, Adel Aljunaibi, MD3, Abdulnaser Alsaid, FRCSC1.
1Ibn Sina hospital, Kuwait, Kuwait, 2University of Wisconsin, Madison, WI, USA, 3Sheikh Khalifa Medical city, Abu Dhabi, United Arab Emirates.
Though laparoscopy is becoming the standard of care in the management of multiple pediatric urology disorders, its widespread use is hampered by the difficulty in acquiring advanced skills. We previously described condensed MIS mentorship program to master simple and ablative pediatric urology procedures. Herein, we describe the mentorship program towards acquiring necessary skills to perform transperitoneal laparoscopic pyeloplasty (TLP) and further report the outcome of this program.
Patients and methods:
Two 5 days workshops were conducted in February and May 2019, whereby two different expert mentors assisted a senior pediatric urologist with limited laparoscopy experience. The design of the course was as following: the mentors presented details of the procedure, tips and tricks and possible intraoperative issues necessating conversion to open approach. In the first two days, the mentee assisted the mentors on the cases, while in the remaing 3 days, the mentee performed the pyeloplasty while supervised by the mentors. All the patient's demographics and pre/post op data were recorded, reviewed with emphasis on indications and outcome of surgery, albeit imaging or symptoms resolution if any.
During the mentorship period( workshop), a total of 20 TLP were done. Mentors operated total 8 cases(M:F 3:5,R:L 2:6, age 1.6- 10.8 years) while assisted by the mentee , operative time ranged from 90 to 110 minutes (average 100 minutes) .The remaining 12 cases( M:F 9:3, R:L 3:9,age 2.8 to 9.8 years) were operated by the mentee and assisted by mentors. Operative time ranged from 180 to 210 minutes (average 195 minutes). In the post mentorship period from July 2019 to March 2022, the mentee performed 85 TLP in 82 cases, (3 bilateral, 2 redo),(M;F 57:25, right :left 38:47,age varies from40 days to 12 years ( 52 cases < 1 year ).
In all cases J-J inserted antegradely, & removed 4 to 6 weeks post operatively. Mean operative time was 135 minutes (100 to 240 min.) in last 20 cases 100 -120 minutes) . There was no conversion to open, only one case developed omental herniation through port site.Mean hospital stay was 23.6 hours (20 to 60 hours).Indication of surgery in all cases during workshop (20) and post mentorship (85) was progressive hydronephrosis by ultrasound (79), drop in function (<40%) (11), symptomatic (pain, UTI) (15) In all post operative cases ultrasound showed improvement in hydronephrosis, and symptomatic cases became symptom free. Follow up ranged from 1 to 35 months.
Structured MIS mentorship programs could assist midcareer practitioners to expand on their practice and develop the necessary skills to perform advanced laparoscopic reconstructive procedures.
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