Volumes of Procedure
The clinical program is designed to provide fellow's with a practical knowledge of the most up to date methods of diagnosing and treating urologic cancers. The aim is to develop familiarity with and stimulate interest in clinical and laboratory studies designed to advance knowledge in the field. The responsibilities for clinical care are shared by the faculty, fellows, residents, medical students, and physician assistants. Fellows are directly involved in the management of patients with urologic malignancies or patients with urologic problems arising from or coincident with the treatment of neoplasms outside the urinary tract. This includes pre and postoperative patient care as well as rotations in medical oncology, radiation oncology, and gynecologic oncology. The volume and nature of the clinical experience is such that the fellow has an opportunity to participate in the management of patients with all types and stages of urologic cancer.
In the past year, over 4,785 new patients were evaluated by the Urology Service. The majority of these patients were surgical candidates. Surgical volume has increased steadily (see above charts). In 2006, we performed 119 retroperitoneal lymph node dissections for testicular cancer, 222 radical cystectomies, 117 radical and 161 partial nephrectomies, and 715 radical prostatectomies, among a total of 2,900 major or minor operations. In the future we expect that a third to a half of these procedures will be done laparoscopically.
The call schedule is shared among the fellows. Fellows are responsible for the patients on their service during the week. Fellows are on call every third weekend with responsibilities for the Urgent Care Center every sixth weekend.
In addition to patient care and clinical research, the Urology Service has a formal program for education in urologic oncology. The training experience is enhanced by a didactics course in urologic oncology (see Didactic Lecture schedule), a course in biostatistics, weekly grand rounds that focus on integrating a multidisciplinary approach to oncology, and weekly research conferences. The goal of the educational program is to provide a broad view of all aspects of genitourinary cancer, and a complete familiarity with all diagnostic and therapeutic approaches. Rotations on medical oncology are supplemented by formal lectures on systemic therapy. Similarly, radiation oncologists lecture on external beam and brachytherapy strategies to supplement the clinical experience in radiation oncology.
Additionally, the urologic oncology fellows participate in the NIH-sponsored Clinical Research Curriculum, directed by Dean Bajorin, MD, who is the Director of the Fellowship Program in Medical Oncology. This extensive course provides trainees with comprehensive, multidisciplinary didactic training in the design, conduct, ethics, and regulatory issues governing research on human subjects to prepare trainees for successful clinical research careers. The course is comprised of four modules taught by faculty from the Departments of Medicine, Psychiatry, Human Genetics, Pediatrics, Radiation, Epidemiology and Biostatistics, Anesthesiology, Neurology, and Surgery. Fellows must take a final written examination in the format presently used by the Medical Knowledge Self-Assessment Program (MKSAP). Certification is required by the NIH for all clinical scientists who plan to conduct clinical trials.
Each fall and winter the Tri-Institutional (Weill Cornell University, Rockefeller University, MSKCC) Ethics Seminars provide instruction to basic/clinical research fellows appointed to institutional training grants, all MD/PhD students, and all predoctoral students regarding scientific integrity and ethical principles in research. The four-week course covers a broad spectrum of issues and is structured with lectures, panel discussions, and small workshops tobe discussed by students and faculty. Problem solving and ethical decision making are also topics that will be addresses during the seminars.
Laparoscopic and Minimally Invasive Surgery Program
Laparoscopic and Minimally Invasive Surgery (MIS) are being adapted to surgical care in general and applied to the specialty of urologic oncology as a result of improvements in instrumentation and increasing experience.
Our mission to promote excellence in clinical and surgical care and training is exemplified by the approach of the MIS program, which seeks to meet or exceed expected open surgical outcomes for patients who elect these procedures. The MSKCC surgeons who perform laparoscopic and robotic-assisted surgery — including James Eastham, Guido Dalbagni, Karim A. Touijer, Jaspreet Sandhu, Brett Carver, and Jonathan Coleman — apply an approach that focuses on duplicating modern oncologic principles of open surgical procedures. The training program in laparoscopy and robotic-assisted surgery encompasses all the major procedures in the field that involve upper-and lower-tractorgan systems, including adrenalectomy and extended lymph node dissection. Reconstructive procedures for the female pelvic floor are also being performed. Multidisciplinary programs under development include image-guided percutaneous and laparoscopic procedures for cryoablation, functional tumor imaging with image guided biopsy and treatment, and lymphatic staging and mapping studies. Fellows are involved on multiple levels through a graduated, continuous training experience, which is designed to provide a sound foundation as they progress toward mastery of advanced laparoscopic and robotic assisted techniques.