Daniel H. Shin

We developed a novel procedure specific simulation platform for robotic partial nephrectomy. In this study we prospectively evaluate its face, content, construct and concurrent validity.

Objectives: To prospectively evaluate the feasibility and safety of a novel, second-generation telementoring interface (ConnectTM) for the da Vinci robot.

Materials and Methods: Robotic surgery trainees were mentored during portions of robot-assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in-room mentoring or remote mentoring using ConnectTM. While viewing 2D, real-time video of the surgical field, remote mentors delivered verbal and visual… Show more

Objectives: To prospectively evaluate the feasibility and safety of a novel, second-generation telementoring interface (ConnectTM) for the da Vinci robot.

Materials and Methods: Robotic surgery trainees were mentored during portions of robot-assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in-room mentoring or remote mentoring using ConnectTM. While viewing 2D, real-time video of the surgical field, remote mentors delivered verbal and visual counsel, using 2-way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. Mentoring interface was rated using a multi-factorial Likert-based survey. Mann-Whitney and T-tests determined statistical difference.

Results: We enrolled 55 mentored surgical cases (29 in-room, 26 remote). Perioperative parameters of operative time and blood loss were similar between in-room and remote mentored cases. Robotic skills assessment showed no significant difference (p>0.05). Mentors preferred remote over in-room telestration (p=0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases utilizing wired (versus wireless) connections had lower latency and better data transfer (p=0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting ConnectTM, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in-room mentored case; no intraoperative injuries were reported during remote sessions.

Conclusion: In a tightly controlled environment, the ConnectTM interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread utilization of this technology. Show less

Introduction
Delayed ejaculation is a small but important subsection of ejaculatory dysfunction, with prevalence estimated at 1–4%. It is most commonly defined by DSM-IV-TR criteria, as “a persistent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.” The pathophysiology of delayed ejaculation is related to disruptions in… Show more

Introduction
Delayed ejaculation is a small but important subsection of ejaculatory dysfunction, with prevalence estimated at 1–4%. It is most commonly defined by DSM-IV-TR criteria, as “a persistent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.” The pathophysiology of delayed ejaculation is related to disruptions in ejaculatory apparatus, nervous transmission, hormonal or neurochemical ejaculatory control, or psychosocial factors.

Conclusion
The evaluation of this condition requires a focused history and physical, which includes a detailed sexual history, examination of the genitalia, and inquiry into the status of the partner. Laboratory tests are aimed at the detection of abnormalities in the blood count, glucose level, hormone levels, or kidney function. If a correctable etiology is discovered, treatment is directed towards the reversal of this condition. In some cases, the delayed ejaculation may be a lifelong problem. Also, in some cases the etiology of the delayed ejaculation may be irreversible, such as in the case of age-related sensation loss or diabetes-related neuropathy. In these instances treatment may require a combination of behavioral modification, sexual therapy, or perhaps pharmaceutical drugs. Participation of the partner in therapy may sometimes be necessary. Future investigations will continue to elucidate the complex biological and psychosocial factors which contribute to delayed ejaculation, leading to more effective treatments. Show less

Since the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures have been routinely employed to treat male infertility owing to azoospermia. With obstructive azoospermia, sperm is potentially harvestable from the vas deferens, epididymis, and testicle using percutaneous and open sperm retrieval procedures that are relatively straightforward and reliable. In nonobstructive azoospermia, sperm is generally found only in the testicles and can often be difficult to retrieve.… Show more

Since the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures have been routinely employed to treat male infertility owing to azoospermia. With obstructive azoospermia, sperm is potentially harvestable from the vas deferens, epididymis, and testicle using percutaneous and open sperm retrieval procedures that are relatively straightforward and reliable. In nonobstructive azoospermia, sperm is generally found only in the testicles and can often be difficult to retrieve. Several approaches aimed at maximizing sperm yield in this condition have been developed, but only 50% of men with nonobstructive azoospermia will have clinically usable sperm. Multibiopsy testicular sperm extraction (TESE), microdissection TESE, and fine-needle-aspiration map-guided TESE are three common methods currently employed to locate and retrieve sperm in these difficult cases. Other factors that influence the use of surgically retrieved sperm for assisted reproduction include differences in sperm DNA integrity, the expertise of the surgeon and the andrology laboratory, and the described differences in the viability of sperm from different anatomical sources after freezing and thawing. Show less

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of low malignant potential most commonly found in the lung, liver, and soft tissues. Here we describe the very rare presentations of primary EHE in the kidney and on the penis. One patient is a 59-year-old man with a renal lesion found incidentally on surveillance radiography, and the other is a 26-year-old man with an asymptomatic subdermal glanular lesion. Both were treated surgically via open partial nephrectomy and partial… Show more

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of low malignant potential most commonly found in the lung, liver, and soft tissues. Here we describe the very rare presentations of primary EHE in the kidney and on the penis. One patient is a 59-year-old man with a renal lesion found incidentally on surveillance radiography, and the other is a 26-year-old man with an asymptomatic subdermal glanular lesion. Both were treated surgically via open partial nephrectomy and partial penectomy, respectively. Surgery is standard treatment, and close clinical follow up is necessary due to the unpredictable nature of EHE. Show less