Benjamin Smith

This was the first week as part of the IMED clinical immersion program! My name is Ben and I am one of the team members of the UIC Urology department group (3 medical students and 2 engineers). We started the program with a didactics day on Monday with lectures and small group activities to help emphasize the importance of observational skills. Tuesday was dedicated to a meeting with our urology IMED program lead, Dr. Young, with a quick overview of expectations and logistical tasks. We met Dr. Garvey (one of the urologists at UIC who we will be working closely will over the summer) and then perused Epic to generate team schedules for observation coverage for the urologists in both the OR and the clinic. Wednesday marked the start of our immersion with three of us working with Dr. Garvey and two of us up in the OR observing procedures. I was located down in the office this day observing new and follow-up patients in the morning and procedures in the afternoon. Some of the procedures we observed were a vasectomy, multiple cystoscopies, and an expressed-prostatic secretion (EPS) fluid collection. Many of the clinical follow-up cases I observed were due to incontinence from unintended drug interactions (typically medication for schizophrenia and depression). I found this interesting and worth looking into for a possible area of innovation in order to predict more personalized outcomes/side-effect risks from common drugs. It was also evident that urine collection via a clean catch was an area of possible focus for our group given the proclivity to incorrect technique during collection (this test is primarily collected by the patient). The cystoscopies were very quick in terms of the rapid results and actual procedure time. They also had fairly sophisticated machinery that seemed to work extremely well. On the last day of the week (Thursday) the teams switched coverage to shadow the opposite of the previous day. Therefore, I was able to go up to the OR and observe Dr. Madueke’s partial nephrectomy conducted with the Da Vinci Xi multiport robot. This was my first time seeing the robot in action (I do have some experience operating it via the surgical advanced education experience UIC offers). The skill the physician and resident had operating the machinery was quite incredible and very effective in terms of minimizing bleeding. One area of interest that was quite glaring was the inability of the surgical team to remove the bagged resected tumor sample from the patient’s body. The tumor was too larger to fit through the port hole, causing the surgeon to need to leave it in the body while the robotic surgery portion was completed. They then turned to widening the laparoscopic hole in order to eventually pull the sample out of the patient. Another IMED group in the past has been working on this unmet need.

Overall this was an amazing week and a good deep dive into the IMED clinical immersion program! I am looking forward to continue to work with the Urology department and gaining more exposure to different procedures, presentations of medical diagnoses, and treatments. Till next time!

This week I was able to be in the operating room Tuesday/Thursday and the clinic on Wednesday. With this busy week under my belt, I was able to come up with some new observations related to the day to day clinic, surgeries, and in office procedures. This entry, however, will focus primarily upon summarizing a peer-reviewed article related to my observations in urology and an exploration of a commercial solution/patent to a current problem within the field.

Focusing on the peer-reviewed article, one question that I was interested in pursuing through research was related to surgical methods for treating urethral diverticula. On Tuesday, I was able to watch an open urethral diverticulectomy in an adult middle-aged female. According to the literature, the gold standard treatment of this condition is a vaginal diverticulectomy with cystoscopy (a surgical approach). The literature did not have much regarding the optimal treatment of this condition, but did have a plethora of case studies reporting surgical techniques.¹ I was able to find one article regarding robotic assisted diverticulectomy with a good patient outcome measured by no surgical/medical complications, minimal intra-operative blood loss, and no recurrence of her urinary symptoms.² The type of robot used was not reported in the literature, but the port placement and general procedure was described in detail. Based on my assessment, robotic procedures (while taking longer based on comparison of the procedure I observed in the OR v. the reported time in the article of 3.5 hours) could present a way to significantly improve intra-operative blood loss. Lacking a clearly outlined randomized controlled trial comparing robotic to open diverticulectomies, there is no clear comparison between the two and future studies will be necessary to identify an optimal treatment plan.

The second portion of this blog will briefly explore the DaVinci Xi surgical robot. While it was not mentioned in the case report regarding the robotic assisted diverticulectomy, it is by far the most commonly used surgical robot (at least at UIH). This device is made by the company Intuitive, which holds multiple surgical robots and their associated attachments. INtuitive holds multiple patents for each device they manufacture which can be found on their company website (68 patents directly related to their Da Vinci Xi robot). Their patents related to this machine were granted in 2010 and will expire in 3 years.³ The particular patent that I looked at described both the actual surgical robotic arms that generate the output as well as the input device that translates the surgeon’s movements. This company has a diverse portfolio surrounding surgical robotics that are patent protected for at least the next three years. I will be definitely looking more into this company in the future with regards to our exploration of surgical innovation.

1. Welch EK, Dengler KL, Welgoss JA. Urethral Diverticulum Marsupialization With Modified Spence-Duckett Procedure. Urology. 2023;176:248. doi:10.1016/j.urology.2023.02.040
2. Mozafarpour S, Nwaoha N, Pucheril D, De EJB. Robotic assisted proximal dorsal urethral diverticulectomy. Int Urogynecol J. 2021;32(10):2863-2866. doi:10.1007/s00192-021-04716-y
3. https://patents.google.com/patent/US7689320B2/en

Our given assignment for this week was to create a slide detailing research related to a particular need that we identified in clinic.

This week was very busy in the clinic and the OR as we continued to observe and interact with the urology care team and patients. Our team came up with many different needs statements last session and received feedback from peers regarding our overview slides. I will share a new slide regarding a workflow need that could improve the clinic efficiency and possible patient satisfaction.