Minimally Invasive, Robotics, and Endourology Fellowship

Application Process

Details here.

Goals and Objectives

Our goal is to train leaders in minimally invasive and endoscopic urology both in community and academic practice. To achieve this goal, we have the following educational objectives:

1. To demonstrate advanced and mastery knowledge in the pre- and post-operative evaluation of diseases of the urinary tract commonly treated with minimally invasive and endoscopic techniques, which are often, but not limited to prostate cancer, renal cell carcinoma, bladder cancer, complex urinary stones, ureteropelvic junction obstruction, and pelvic organ prolapse.
2. To develop advanced and mastery knowledge in the surgical equipment and techniques of minimally invasive and endoscopic surgery, which are often, but not limited to robotic prostatectomy, robotic partial/radical nephrectomy, robotic radical cystectomy, robotic pyeloplasty, robotic sacrocolpopexy, percutaneous renal access, percutaneous nephrolithotomy, and ureteroscopy with lithotripsy.
3. To demonstrate advanced and mastery ability in managing the continuity of care for a panel of patients from ambulatory consultation to pre-operative visit to operative intervention to post-operative visit to long-term surveillance.
4. To develop a foundation or advanced skill in research design, implementation, and analysis.
5. To identify systems issues in process, safety, and quality, and actively work to improve these areas.
6. To strengthen a pattern of behavior consistent with self-directed and life-long learning.
7. To be devoted to the teaching of peers and colleagues.

Curriculum

The fellow will be primary based at the Hospital of the University of Pennsylvania. This is the flagship acute care hospital and primary academic teaching site within the University of Pennsylvania Health System. It also serves as a quaternary referral center for the larger Mid-Atlantic region. This is home to our cancer center and complex urinary stone program. It is common to see patients referred from all the country and world to have robotic surgery. Here the fellow will join either Dr. Thomas J. Guzzo or Dr. Daniel Lee with their robotic oncology cases, primarily focusing on robotic prostatectomy and robotic partial and radical nephrectomy. There is also opportunity to gain experience with single port robotic benign and oncology cases with Dr. Benjamin Schurhamer. These opportunities will occur approximately 1-2 times per week. In addition, the fellow will join Dr. Justin B. Ziemba for his percutaneous nephrolithotomy cases where there will be instruction in renal access. In addition, there will be opportunities for participation in other complex, large volume ureteroscopic stone cases. This will be approximately 1 time per week.

The fellow will also have an opportunity to operate at Pennsylvania Hospital. It is the Nation’s first hospital. This is in the heart of the historic Philadelphia district and a short drive from the other 2 hospitals. It is a community-based hospital, but increasingly seeing complex urological cases, particularly robotic upper urinary tract and pelvic reconstruction. The fellow will also spend time with Dr. Phillip Mucksavage who has a robust robotic oncologic surgery practice. He is also busy with complex stone disease, which will be another opportunity to gain training in percutaneous nephrolithotomy with renal access. There is also an increasing emphasis on robotic upper urinary tract reconstruction at Pennsylvania Hospital with support from faculty member and reconstructive expert Dr. Robert Caleb Kovell. This is also home to our female pelvic medicine and reconstructive surgery and voiding dysfunction program. Here the fellow will operate with Dr. Ariana L. Smith for robotic pelvic and reconstructive surgery. Operating at Pennsylvania Hospital will be approximately 1 time per week.

Finally, the fellow will also operate at Penn Presbyterian Medical Center, which is only a few blocks from the Hospital of the University of Pennsylvania. This is a tertiary referral center for the tristate area. It is home to our high-volume oncologic robotic surgery program, including RPLND. However, it is also a primary site for community-based urology for the surrounding West Philadelphia and University City population. The fellow will be with Dr. Phillip M. Pierorazio and Dr. Daniel Lee in his operative cases approximately 1 time per week.

In the operating room, the fellow will have primarily console time as the tableside assistants are dedicated PA. Minimal tableside assisting will be performed in the early part of the training to ensure competency in this important aspect of the procedure.

In addition, there will be continuity fellow’s clinic approximately 1 time every other week as well as your own dedicated half day afternoon operating room time to schedule cases from clinic. This will provide you with a guided and mentored opportunity to build confidence, skill, and organization in managing your own practice.

Combined our faculty will perform nearly 1000 robotic cases per year across the range of subspecialties. In addition, our faculty will perform nearly a total of 120 percutaneous nephrolithotomy and 600 ureteroscopic cases per year for complex stone disease. This volume and breadth is unmatched with other fellowship programs.

Finally, it is our expectation that this will be a 1-year combined robotics/laparoscopic and endourology fellowship. However, should you prefer focusing on one area of expertise over another, then we can make appropriate adjustments and accommodations within the guidelines set forth by the Endourological Society for accreditation to be sure that your fellowship experience matches your preferred learning. To that end, we are now one of the few fellowship programs who have received approval to offer the new Minimally Invasive Urologic Oncology program from the Endourological Society. 

Sample Weekly Schedule

Week 1

Week 2

Week 3

Week 4

HUP - Hospital of the University of Pennsylvania
PPMC - Presbyterian Medical Center
PAH - Pennsylvania Hospital

Evaluation Methods

The fellow is expected to participate fully and faithfully in their clinical and research duties. The fellow will receive at least monthly feedback on his/her progress pertaining to surgical skill acquisition and patient management. This evaluation is performed as part of the standard protocol for all surgical fellowships within the Department of Surgery at the University of Pennsylvania.

The fellows are allowed autonomy in a graded fashion. This occurs through a mastery learning model. In this model, for example, in a robot prostatectomy case, the fellow is expected to perform a predefined section of the procedure, such as developing the space of Retzius until this portion is performed in a proficient manner. Once this step is mastered, then the fellow is advanced to the next step in the progression. We believe that this model allows for immediate, actionable, and specific feedback to ensure mastery of a technical skill.

Research Experience

The fellow will be mentored in scholarly activities with opportunities for involvement in clinical trials, health services research, clinical outcomes studies, education/simulation, and quality improvement, depending on interests. Fellows will be encouraged to engage in these projects as a framework in which to learn and expand their research skills, build their research portfolio, and develop a foundation for later funded or independent research/scholarship. We expect the fellows to publish their work as well as present their findings at international, national, and regional scientific meetings.

We have several privately and federally funded research projects currently on-going, which provides a rich environment. There is protected research time built into the monthly schedule to ensure that there is ample opportunity to participate in these research projects and complete meaningful and quality work. 

We have dedicated research staff to perform database management and maintenance, obtain patient consent, and regulatory duties required from the IRB and FDA. We have ongoing collaborations with our departments in medical oncology, pathology, radiology, radiation oncology, bioengineering (specifically robotics), and biostatistics. 

Finally, the University of Pennsylvania is rich in academic opportunity. Fellows who are interested in health economics and health policy are encouraged to join the Leonard Davis Institute of Health Economics. There are also opportunities for innovation or to participate in quality improvement or patient safety through the Center for Healthcare Improvement & Patient Safety. Penn Medicine also has a state of the art and robust clinical simulation center with robotic, laparoscopic, and percutaneous trainers which can be used for educational research.