Our Bladder Cancer research program has several aspects:
We house the International Robotic Cystectomy Database (IRCC), the largest robotic cystectomy database in the world. This is a multinational and multi-institutional database with 41 surgeons and 23 institutions from 14 countries. The ATLAS Program has developed and published a technique for intracorporeal W- neobladder that may further popularize intracorporeal continent diversion.
Another important aspect is Surgical Quality. The ATLAS Program developed the Quality Cystectomy Score (QCS) that measures the quality of surgical performance independent of the patient and disease characteristics, and therefore allows for consistent comparative effectiveness research among different bladder cancer programs. This score can provide important information for patients, insurance companies, and for institutions to serve and audit surgical performance.
In addition to Dr. Guru’s pioneering work in the development of robotic surgical simulators and training curricula, we developed and validated different scoring systems in collaboration with world-renowned experts. We have already published 4 scoring systems.
(Mind Maps project)
With advents in robot-assisted surgery, it became crucial to understand more about human brain and machine interaction, and how this affects learning, skill acquisition, mental and physical workload. We were the first to study the difference in cognitive function between experts and novices, and also during different stages of surgery. We also described the process of mentorship during robot-assisted surgery, and how this can help cognitive learning side by side with physical training.
Operating room environment for robot-assisted surgery
Introduction of robot-assisted surgery has been associated with changes in the operating room layout. Also, the physical separation of the surgeon (on the console) from the patient and the rest of the team may affect communication and team dynamics in the operating room. We developed a methodology that can capture different team activities during robot-assisted surgery. Furthermore, we mapped team dynamics as well procedural interruptions and reviewed the different methods that can be used to optimize performance in the operating room and avoid adverse events.
In collaboration with our basic science researchers, we are looking at the mechanism of local recurrence after bladder cancer, and the effect of pneumoperitoneum on peritoneal immune response against tumor cells. This work has been awarded the best poster presentation in the national meeting (AUA 2016, San Diego), and was invited for AUA News.
- Develop a statistical model to predict operative times to help OR scheduling
- Investigate workload during robot-assisted surgery
- Implement and audit the cystectomy pathway for bladder cancer.
- We are also collaborating towards developing bladder cancer organoids that can be used as models mimicking bladder cancer, and provide ideal environment to investigate tumor behavior and response to different therapies.