BackTable Urology

In this episode, host Dr. Jose Silva speaks with Dr. Duke Herrell, CEO and CMO of Virtuoso Surgical, a robotic surgery tool known for its exceptional dexterity and precision.

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SHOW NOTES

Dr. Duke Herrell is a minimally invasive urologic surgeon and professor at Vanderbilt University. Dr. Herrell came to Vanderbilt for his surgical fellowship, where he met Bob Webster, a mechanical engineer who had developed concentric tube robots made out of an elastic metal. Together, they worked to form the metal into curves that could create a tentacle-like motion for clinical applications. Over the next 15 years, Dr. Herrell and three co-founders started their company, Virtuoso Surgical, and received grant funding to move forward with their startup.

The surgical device features two 1-millimeter dextrous tools inserted through a rigid scope that is capable of carrying a versatile array of instruments. The device is currently intended for the urologic procedures including removal and enucleation of prostate tissue, bladder lesion removal and sampling, and transurethral resection of bladder tumors (TURBT). Notably, the device addresses a critical issue in tumor staging by improving the accuracy of margin determination, which is a game-changer for the 50% of TURBT procedures that yield specimens lacking muscle or clear margin information. Beyond urology, the device has the potential to improve other surgical procedures that utilize a rigid scope in a constrained environment including pulmonology, neurosurgery, and ENT interventions.

Dr. Herrell and his team are also developing EndoTheia, a micromachine instrument that functions as a steerable catheter, specifically designed for flexible ureteroscopy. This device is currently in the verification and validation phase.

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RESOURCES

Virtuoso Surgical:

https://virtuososurgical.net/

In this episode of Back Table Urology, Dr. Aditya Bagrodia, Dr. Joshua Langston, and Dr. Mara Holton from the Large Urology Group Practice Association (LUGPA) share insights on the financial and administrative complexities that urologists face.

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CHECK OUT OUR SPONSOR

Fellow

https://www.meetfellow.com/

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SYNPOSIS

The doctors delve into the increasing costs of healthcare, the challenges posed by regulatory requirements, and the significance of physician leadership in influencing healthcare delivery. The discussion also highlights the importance of advocacy, the evolving role of physicians in business and policy, and actionable steps doctors can take to ensure their voices are heard. Finally, the doctors address the growing trend of hospital employment among physicians and its impact on rural healthcare access.

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TIMESTAMPS

00:00 - Introduction

06:41 - Complexities and Costs in Healthcare

11:48 - The Role of Physicians in Healthcare Leadership

17:21 - The Shift Towards Hospital Employment

27:35 - Economic Pressures on Physicians and Patients

30:09 - Cost Discrepancies in Medical Procedures

38:16 - Burnout and Workforce Challenges

49:26 - Advocacy and Call to Action

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RESOURCES

Fellow

https://www.meetfellow.com/

BackTable URO Ep. 82- Advocacy Basics for the Urologist: From Your Clinic to Capitol Hill with Dr. Ruchika Talwar

https://open.spotify.com/episode/0hcLrKuf5QU7TZCHSErs4Z?si=842c7985f44c4e04

BackTable URO Ep. 164: Urology Advocacy: From Passion to Policy with Dr. Seth Cohen, Dr. Michelle Leach, and Dr. Suzette Sutherland

https://open.spotify.com/episode/68pR7MxFIgQ1HJLy6xQHDX?si=36a93eedd6594770

In this episode of BackTable Urology, Dr. Bagrodia interviews Dr. Peter Scardino, world-renowned urologist and professor emeritus of urology at Memorial Sloan Kettering Cancer Center (MSK), about his journey to becoming a urologist and life lessons he has learned along the way.

Dr. Scardino was born in Portsmouth Naval Hospital at the end of World War II and grew up in Savannah, Georgia. The fact that his father was a urologist and his attendance at a National Science Foundation special summer science program started his interest in medicine. He had an early interest in science and worked harder than anyone else. This work ethic led him to pursue an undergraduate degree at Yale and a medical degree at Duke. Then, he trained in general surgery at Massachusetts General and pursued urology training at UCLA.

Dr. Scardino also speaks about his experience in hospital administration and business management. We discuss how he was inspired to gain knowledge in the field, and how a group of faculty members got together to learn from a retired businessman and the University of Houston. He shares personal stories about his mentors and insights on how mentors can help guide people to their best interests. He also emphasizes the importance of engaging in leadership and administration early on in a career.

Additionally, he shares about the challenges he faced when making the decision to move from being chair of urology at Baylor College of Medicine to Memorial Sloan Kettering. They also discuss the division of attitudes towards making urology a department, and how it affected Dr Scardino's personal life. Finally, Dr Scardino reflects on the lessons he has learned throughout his career and the importance of striking a balance between work and personal life.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Bilal Chughtai discuss their workup for benign prostate hyperplasia (BPH) and how they use Greenlight Laser therapy and pharmacologic interventions to treat this common condition.

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CHECK OUT OUR SPONSOR

Boston Scientific GreenLight Laser Therapy

https://www.bostonscientific.com/greenlight

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SHOW NOTES

First, the doctors discuss workup of BPH. Questionnaires, like the International Prostate Symptom Score (IPSS) are helpful when in the first clinic evaluation. They also discuss differential diagnoses of urinary obstructive symptoms.

Then, they discuss who is and isn’t a candidate for a GreenLight laser therapy. They also touch on the topic of pre-operative antibiotics. Dr. Chughtai then describes in detail the steps of the procedure to ensure an open channel and removal of the correct prostate lobes. Next, he discusses the possible risks and benefits of doing an ejaculatory hood sparing procedure. Additionally, they explore the hood technique and how it's used to preserve mucosa at the apex of the prostate.

They also consider the importance of having a discussion about ejaculation with patients before the GreenLight procedure. Additional technology or adjunctive medications, such as alpha blockers and PDE5 inhibitors may be necessary as well. Finally, Dr. Chughtai explains his post-operative medications and the decision to discharge or admit for overnight observation.

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RESOURCES

GreenLight Laser Therapy:

https://www.bostonscientific.com/en-EU/health-conditions/enlarged-prostate/our-treatments/greenLight-laser-therapy.html

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with PGY4 urologist Dr. Chloe Peters (University of Washington) and OB/GYN Dr. Beverly Gray (Duke University) about their work in women's health and advocacy, and how the Dobbs ruling has impacted their respective medical fields.

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SHOW NOTES

First, the doctors explore the implications of state abortion laws on the OB/GYN and urology workforces and how they may directly impact where people choose to live and work. Dr. Peters and Dr. Gray explain the complexities of state abortion policies, as well as the differences between restrictive and nonrestrictive states. The Dobbs ruling in June 2022 gave individual states the power to regulate any aspect of abortion not protected by federal law, thus overturning Roe v. Wade. Both doctors emphasize that this ruling affects all urologists and OB/GYNs in private and academic settings, because they provide unsafe environments for patients who need them.

Recent studies and surveys show how restrictive abortion laws are impacting the urology rank lists and applications. One in five applicants to the urology match took programs off their list because they are located in states with illegal abortion laws, and almost 60% said they would worry about their health and safety if they matched in a state with restrictive laws. In summary, all three doctors agreed that restrictive laws can have a direct impact on residency and urology recruitment efforts.

Finally, they observe that the increasing diversity in the field of urology has encouraged younger, female members to advocate for better access to healthcare. They remain optimistic that the current generation can use their voices to create change and provide better access to care for all.

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RESOURCES

American Urologic Association (AUA) Position Statement on the Supreme Court’s Decision to Overturn Roe v. Wade

https://www.auanet.org/about-us/aua-statement-on-overturning-roe-v-wade

American College of Obstetricians and Gynecologist (ACOG) Abortion Policy

https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/abortion-policy

Ryan Residency Training Program

https://ryanprogram.org/