Research

Minimally Invasive Surgery

The Division of Urology at the University of Cincinnati is committed to increasing the knowledge of urological diseases and improving the quality of patient care. We are actively involved in clinical, educational, and basic research projects. The following summaries provide insight into our current projects in minimally invasive technology and education:

The Role of Haptic Feedback in Laparoscopic and Robotic Surgery:

Haptic (tactile) feedback is considered by many surgeons to be an important component of laparoscopic surgery. Despite the presumed importance of haptics in laparoscopy, there is a paucity of evidence-based research that addresses the role of tactile feedback during laparoscopic surgery. Robot-assisted laparoscopic surgery which has revolutionized minimally invasive surgery lacks lacks haptic feedback due to the robot interface due to the separation of the surgeon who works from a console from the patient on the operating table. However, unlike laparoscopic surgery, robot-assisted laparoscopic surgery provides a 3-dimensional view (enhancing depth perception) and an intuitive wrist articulation at the tips of the robotic instruments. The favorable outcome of robotic surgery suggests a possible operator visual compensation for the lack of tactile feedback. To determine the role of haptic feedback in laparoscopic surgery, we are evaluating the ability of surgical trainees to perform laparoscopic tasks in the lab using a virtual reality simulator in haptic and non-haptic environments. The surgical performance of the trainees is evaluated using motion tracking technology to measure the accuracy, the economy, and the speed of their hand motion.

Laparoscopic Partial Nephrectomy for Small Size Kidney Tumors:

Laparoscopic partial nephrectomy has recently emerged as a surgical option for selected renal masses. Large series have documented the techniques, low morbidity and oncologic efficacy of the approach. Open surgerical techniques, such as the necessity for vascular control and hypothermia are still debated. The major impediments to performing laparoscopic partial nephrectomy remain the difficulty associated with control of bleeding, and repair of the collecting system after removing the tumor. While bleeding is temporarily controlled by occlusion of the renal vessels during excision of the tumor and repair of the defect, the duration of renal artery clamp time must be short to minimize damage to the kidney. We are incorporating the use of the robot in this procedure to exploit the greater precision of repair in the 3-D environment and “wristed” instruments not present in the traditional laparoscopic method.

Low-Cost, Disposable, Simulated Tissues:

Training of future urologists will depend heavily upon simulation of procedures in both open and laparoscopic/ endourologic procedures. Simulation will allow training in operative techniques outside the operating room and facilitate teaching and assessment of skills before the trainee participates in surgical procedures. We are developing inexpensive, high-fidelity, low-tech biosynthetic tissues (BSTs) and employing them in the surgical training of residents and medical students. BSTs serve the surgical training for open, laparoscopic, and microscopic surgical techniques.

Robotic-Assisted Laparoscopic Radical Prostatectomy( RALRP):

RALRP has recently emerged as the treatment of choice for early, organ-confined prostate cancer. We are prospectively assessing our RALRP procedures and analyzing our results in order to improve the surgical and oncologic outcomes to ensure the highest quality of care for our patients.