“Creating Tomorrows’ Leaders in Urology”
(Leadership, Research and Training in Minimally Invasive Urological Surgery)
Co-Directors
Ralph V. Clayman, MD
Distinguished Professor
Endowed Chair in Endourology
Dean Emeritus
Jaime Landman, MD, FRCS
Chair & Professor of Urology & Radiology
Endowed Chair in Urological Surgical Oncology
Faculty
Robotic and Laparoscopic Oncology
Thomas E. Ahlering, MD
Professor of Urology
Endowed Chair in Urologic Oncology & Schlosberg Family Endowed Chair in Urologic Oncology
Sohrab Ali, MD, MSc, FRCSC
Assistant Professor of Urology
Michael A. Daneshvar, MD, MS
Assistant Professor of Clinical Urology
Division Chief of Urologic Oncology
Associate Program Director of Residency Program
Greg Gin, MD
Assistant Clinical Professor
Jaime Landman, MD, FRCS
Chair & Professor of Urology & Radiology
Endowed Chair in Urological Surgical Oncology
Edward Uchio, MD, FACS, CPI
Professor of Urology
Director of Clinical Trials Research
Jerry D. Choate Chair in Urologic Oncology
Urolithiasis: Medical Management, ESWL, Ureteroscopy, and PCNL
Roshan M. Patel, MD
Vice Chair of Education & Research
Associate Professor of Urology
Division Chief of Endourology
Director of Kidney Stone Center
Ralph V. Clayman, MD
Distinguished Professor
Endowed Chair in Endourology
Dean Emeritus
Pengbo Jiang, MD
Assistant Professor of Urology
Ramy Yaacoub, MD
Associate Professor of Urology
Laser Enucleation of the Prostate: Holmium and Thulium
Akhil K. Das, MD, FACS
Professor of Urology
Bruce Gao, MD
Assistant Professor of Urology
Overview
The Minimally Invasive Urology Training Program at the University of California, Irvine is an Endourology Society approved training program specifically and carefully tailored to train future academic leaders in the world of minimally invasive and noninvasive urology. The directors of this program have been training fellows in Endourology longer than any other academic center world-wide.
Graduates of the program, when it was first initiated at Washington University and then continued by Drs. Landman, McDougall, and Clayman at UC Irvine, include 7 Chairs of Urology. Upon graduation, over 75% of the fellows have gone into academic urology. While many endourology fellowship programs have gone to a one-year experience, it is our firm belief that academic urology is becoming, more, rather than less complicated. As such the skill set for success includes a firm grounding in research and leadership as well as extensive clinical specialty training in oncology and urolithiasis.
Accordingly, the UCI fellowship includes a master’s curriculum, should the fellow so desire, in Biomedical and Clinical Translational Science. Also, a leadership training program is available to the fellow through the Merage School of Business at UC Irvine in order to further provide the administrative leadership and know-how that will equip the fellow with tools/knowledge for a successful career in academia.
The intensive two-year Endourology fellowship is designed to train highly skilled leaders in research and in all aspects of endourology. The initial year is largely spent in the laboratory with a 30% participation in clinical activities. The endourology laboratory is well-established and includes in vitro bench-top as well as in vivo animal research. The fellow works closely with Drs. Clayman, Landman, and Patel to organize the laboratory and participates in weekly laboratory meetings at which time the status of all ongoing projects is reviewed. All students in the laboratory report directly to the fellow, who meets with them on a weekly basis to review progress on their projects.
During the second year, the majority of time, 70%, is spent in mastering clinical skills in all aspects of minimally invasive urology; these include multi-port and single port robotics, laparoscopic procedures, percutaneous nephrolithotomy (using fluoroscopy and ultrasound access), ureteroscopy, and laser enucleation of the prostate ( HoLEP). In addition, there is a focus on the use of GU ultrasonography, especially as it would apply to in – office ultrasound guided biopsy of renal masses and operating room initiation of the percutaneous nephrostomy tract. Also, the training program incorporates highly skilled, fellowship-trained urologic oncologists: Drs. Thomas Ahlering, Edward Uchio, and Sohrab Ali assisted by other oncology focused faculty, Drs. Michael Daneshvar and Greg Gin. Additionally, training in holmium and thulium laser enucleation of the prostate is provided by Dr. Akhil Das, one of the world’s leaders in this procedure, assisted by Dr. Bruce Gao, also fellowship trained.
The technical training and investigative components of the training program are enhanced by unique world-class laboratory resources. The laboratory incorporates five distinct training facilities: a survival operative suite, an animal vivarium, a non- survival operative suite with 6 operative stations, a surgical simulation and laparoscopic trainer suite with 6 laparoscopic pelvic trainers, and a fresh tissue laboratory with an additional 4 operative stations. Furthermore, the program is one of the few in the country with a dedicated laboratory da Vinci (SI) surgical robot. The available facilities and advanced surgical equipment allow the potential for a broad array of experiments to be designed and completed.
Indeed, the only limits on the fellow’s productivity during the fellowship is the range of her/his creative/innovative capabilities. Expert full-time urology dedicated staff are available to optimize productivity in the laboratory. Staff dedicated to the minimally invasive urology team includes a full time biomedical basic scientist (Dr. Michael Wu), research coordinator (Erika Martinez Carcamo), a full-time laboratory director (Dr. Olga Derbeneva), and the services of a statistician for study design and execution. The laboratory also works closely with Dr. Xiaolin Zi, PhD, who runs an NIH and Department of Defense supported basic science laboratory through the Department of Urology with a focus on prostate and bladder cancer. Furthermore, UCI is a highly collaborative campus and the endourology laboratories have ongoing projects with faculty members in radiology, nephrology, the School of Engineering and CalIT2. Current research includes surgical education and training, surgical simulation, development of novel minimally invasive devices, surgical pharmaceuticals, materials development, improved radiographic targeting and imaging for endourological procedures, endoscope development, and virtual reality for preoperative planning.
Program Description
This is an all-encompassing two-year training program. The fellow is granted a clinical instructor appointment. During the two years of fellowship the fellow is expected to take call on the faculty rotation once every 6 weeks. During the first year, the fellow spends up to 70% of the time focused on the laboratory and 30% focused on clinical work. The robust resources and large number of students participating in the laboratory allow for the fellow to remain clinically active while obtaining a strong laboratory experience. The fellow is considered the team leader for laboratory and clinical research and directly manages/organizes the work of the undergraduate students, medical students, as well as international visiting scholars. In the laboratory the fellow leads and supervises the laboratory experiments and researchers. The focus of the laboratory efforts is on translational research as it applies to all aspects of minimally invasive Urology, ranging from the development of instrumentation to studies of a pharmacological nature and beyond to encompass artificial intelligence and virtual reality. We encourage our fellows to tailor projects that stimulate their interest and expand their technical skill sets in order to create an extremely productive scientific experience replete with attention paid to data collection and analysis as well as presentation skills and manuscript preparation.
The clinical component of the training program is the main focus during the second year of the fellowship. This includes a focus on the development of advanced technical skills in the operating room, developing familiarity and dexterity with advanced instrumentation, and expanding surgical judgment and experience. The breadth of procedures cover PCNL (both fluoroscopic and ultrasound access – prone and supine), ureteroscopy, shock wave lithotripsy, laparoscopy, laser enucleation of the prostate, and robotic techniques (single port, multiport, transperitoneal and retroperitoneal). Additionally, the fellow participates in the design and implementation of clinical trials. In year two, the fellow has a personal clinic one half day per week and will therefore be able to generate cases as well as be very involved with the cases of the attendings on the endourology service.
Research Facilities
There are five independent facilities that compose the UC Irvine Surgical Education Center Laboratory: a survival operative suite, an animal vivarium, a non-survival operative suite with 6 operative stations, a surgical simulation and laparoscopic trainer suite, and a fresh tissue laboratory with an additional 4 operative stations. The animate and inanimate laboratory is a facility managed by the Department of Urology and used in conjunction with other school of medicine departments.
The laboratory incorporates a wide range of high-end specialized equipment, including a dedicated daVinci Si robot. Lastly, staffing includes a full-time research coordinator and laboratory director who are members of the minimally invasive urology team to assist with technical training in this facility. The fellow interacts closely with the laboratory director; they work together to run the laboratory and minister to the various projects.
Robotic surgery is currently strongly emphasized in the UC Irvine minimally invasive urology program. We currently have both the da Vinci Xi and SP at all clinical training sites s (in addition to the laboratory system).. All robotic systems are very actively used by the minimally invasive urology faculty members for over 200 cases per year.
In addition, there is an emphasis on laser enucleation of the prostate using both holmium and thulium lasers. This program is run by Dr. Akhil Das, who is internationally renown for his expertise in laser enucleation of the prostate. He has one of the world’s largest experiences in this procedure. Joining him, following his fellowship, is Dr. Bruce Gao. Our laboratory and training facilities are located within a few hundred yards of the hospital and thus it is a short walk to help coordinate our clinical and research activities. In addition, at any given time there are typically 1 to 3 international scholars who observe surgery and help facilitate the team’s research endeavors. Undergraduate students and graduate students (eg. School of Engineering) from the University of California campus are frequent collaborators in the minimally invasive urology laboratory. Additionally, there are continuous interactions with other University of California, Irvine resources such as the School of Engineering and CalIT2. This provides a unique opportunity for the fellow to serve in an administrative leadership role as the medical director of the laboratory. Indeed, the administration of the laboratory is an important part of the training of the fellow and prepares our fellows to lead their own laboratory in the future.
Principal Accountabilities
Basic/Clinical Research (Year One: 70% research and 30% clinical):
Upon the initiation of the training program the fellow is granted full attending privileges and is given the academic title of clinical instructor. Significant time during this year is spent doing translational or clinical research in minimally invasive urology. Each fellow “inherits” a series of ongoing projects. Typically, the fellow will have one major project and several minor projects. Combining the primary project with ongoing projects, it is typical for the fellow to be primary author or co-author on between 5 and 10 peer reviewed publications. Of note, a favorably reviewed manuscript submitted for the annual World Congress of Endourology essay contest is an essential component of the graduation requirements.
All laboratory projects are closely supervised by Drs. Landman, Clayman, and Patel. Laboratory meetings occur on a weekly basis (7:00-8:30am Thursday mornings) to review progress and future directions; these meetings are attended by the entire faculty and staff of the minimally invasive urology team. The fellow’s primary responsibility is to become familiar with all ongoing projects. Each member of the laboratory is a lead on a project; all the other members of the laboratory comprise a team to help that individual’s project be successful. In this manner, all of the people in the laboratory are interconnected and tuned into the collective success of the group as well as of the individual. The fellow participates as a major proponent/ supporter of this culture of collaboration.
Clinical Component of Training Program (Year Two: 70% Clinical and 30% Research):
The major clinical responsibility is the care of minimally invasive surgery patients at UC Irvine Medical Center. The fellow will have active involvement in a wide range of laparoscopic, robotic, ureteroscopic, percutaneous, and laser enucleation procedures. The fellow will also have his/her own clinic one half day per week at our University urology patient care center. During this year, it is expected that the fellow will be able to perform the cases generated from their clinic independently while also training residents in endourological procedures.
Responsibilities:
Fellows are expected to perform clinical duties in preparation for all cases they perform. Chart review to understand each patient’s history, obtaining and evaluating all relevant radiographic studies, and review of relevant laboratory results are all responsibilities of the fellow who should consider each case as if they were the primary physician. The fellow will be on the faculty call rotation; usually 1 in 6 weeks. During this year, it is anticipated that the fellow will be preparing manuscripts regarding the research completed during the initial year of the program. In addition, new clinical research protocols will likely be initiated, advanced, and/or completed. It is anticipated that the fellow will attend the World Congress of Endourology during the second year in order to present their accepted abstracts. The fellow will also be required to fulfill all of the responsibilities of the Endourological Society including, but not limited to, preparation of a clinical case log and preparation of a manuscript for submission to the essay contest. The latter must be graded as suitable for publication in order for the fellow to receive an official diploma from the Endourology Society. Graduation from the UC Irvine minimally invasive urology training program is contingent upon obtaining Endourological Society approval. Administrative support will be available to the fellow via the administrative assistants working for Drs. Landman, Clayman, and Patel..
Teaching and Training
Training, Education, Experience, and Other Requirements:
Candidates must be board eligible urologists or have recently passed the FLEX exam with application made for Urology Board eligibility. They must also have a valid California medical license prior to beginning the fellowship.
Physical Demands:
Must be able to assist in patient handling during emergencies and fulfill all of the duties previously noted.
Vacation and Educational Leave Policy:
The fellow is required to notify Dr. Landman, in written form, for any period of absence whether due to vacation or educational leave. This is essential to insure the smooth operation of the UC Irvine minimally invasive urology team. The fellow should make arrangements to have all of their responsibilities covered (e.g., clinic, call schedule, laboratory meeting presentation, operating room, and laboratory responsibilities). Educational leave shall be granted and not be counted as vacation if the fellow is either presenting the results of research or if the fellow is undergoing clinical training as part of an education program. All other time away (i.e. job interviews, etc.) will be counted in the three weeks that are available for personal vacation.
The UC Irvine minimally invasive urology team will fund reasonable expenses for the World Congress of Endourology during the clinical training program year and for the annual AUA meeting provided the fellow has a presentation(s) at the meeting.
Salary:
The fellows are paid through UC Irvine as per their policies. The annual training program salary is $78,900 per year. All fellows are employees of University of California, Irvine with benefits provided through UC Irvine.
Visit the Endourology Society Website
www.endourology.org
Interested Parties Should Contact:
Ralph V. Clayman, MD
Distinguished Professor
Endowed Chair in Endourology Dean Emeritus
Email: rclayman@hs.uci.edu
Jaime Landman, MD, FRCS
Chair & Professor of Urology & Radiology
Endowed Chair in Urological Surgical Oncology
Email: landmanj@hs.uci.edu
Roshan M. Patel, MD
Vice Chair of Education & Research
Associate Professor of Urology
Division Chief of Endourology
Director of Kidney Stone Center
Email: roshanmp@hs.uci.edu