Columbia University Minimally Invasive Urologic Oncology Fellowship

The Columbia University Minimally Invasive Oncology Fellowship has been specifically and carefully designed to train future leaders in the world of minimally invasive urology.  This is an intensive two year program designed to allow the graduating fellow to have advanced technical skills in laparoscopy, endoscopy and open surgery to optimize patient outcomes with minimally invasive surgical technique.  The fellowship also focuses of developing minimally invasive thinking processes such that the fellow, after graduation, can advance the future of minimally invasive urology.  Research training is focused on creative and dynamic innovation, study design and execution, and proper presentation.

The fellowship incorporates all of the traditional elements of minimally invasive urology including laparoscopy, robotics, endoscopy, ESWL, and stone disease.  The fellowship has, however, additionally incorporated highly skilled and well trained Urologic Oncologist, Drs. Mitchell Benson and James McKiernan, who are an important part of the minimally invasive fellowship and laboratory. The Columbia University minimally invasive urology laboratory is designed to both be academically productive as well as to be a fertile training ground for future leaders of minimally invasive urology.  The laboratory facilities incorporate an inanimate training facility with laparoscopic and virtual reality trainers , a non-survival laboratory, and a survival laboratory.  Expert full-time staff is available to optimize productivity in all three laboratories. The focus of the laboratory is dynamic and innovative research that can often rapidly be translated into clinical practice.  The extensive laboratory resources as well as collaboration with faculty from other departments within Columbia University allow fellows to realize and extend their creative potential.

Current research directions include surgical education, minimally invasive surgical energy technologies, novel anastomotic techniques and devices, surgical pharmaceuticals, urinary tract physiology, novel ablation technologies, novel applications of ablation technologies, improved radiographic targeting and imaging, surgical optics and digital technologies, and novel mechanisms for the protection of the kidney from ischemia.  The team has already developed techniques and concepts that have changed minimally invasive urologic surgery (intrarenal cooling technique and Kyle’s renal anatomy) which has won several international awards. The Columbia University Minimally Invasive Urology Fellowship is unique in the depth and breadth of the dedicated faculty.  Currently, the fellowship is directed by Drs. Jaime Landman (Director of Minimally Invasive Urology) and James McKiernan (Vice-chairman of the Department of Urology and Director of Urologic Oncology) and incorporates dedicated, fellowship trained, faculty in endourology (Dr. Mantu Gupta), robotic surgery (Dr. Ketan Badani), and ablation (Dr. Aaron Katz). 

 Program Description:  This is a two year fellowship. The laboratory experience will focus on endourological, laparoscopic, and basic science research. We work with each individual fellow to tailor projects that stimulate his/her interest and work within his/her existing skill sets.  The projects are aimed at addressing existing clinical challenges. The clinical responsibilities focus on oncologic, endourological, laparoscopic, ESWL procedures. The fellow will be responsible for the enrollment of patients in clinical studies, and with the accrual and interpretation of data in those studies. The clinical fellow will also run their own clinic one half day per week and will therefore be able to generate their own cases as well as be involved with the cases of the three attendings that compose the endourology service.

Clinical Volume (June 2005-June 2006)

Research Facilities:  There are three independent facilities that compose the Columbia University Minimally Invasive Urology Laboratory. 

The inanimate laboratory is a facility used in conjunction with general surgery.  The facility incorporates inanimate trainers and virtual reality training systems to optimize pre-clinical training.  There is a full time international training fellow who is a member of the minimally invasive urology team to assist with technical training in this facility

The non-survival laboratory is used for in vitro work as well as for non-survival animal surgery.  Mr. Santos Cabreriza runs this facility and is very helpful in supporting our research endeavors.  The facility is well equipped with a wide variety of laparoscopic and endoscopic equipment and has fluoroscopy available.

The Survival laboratory is the primary work space for our research and is directed by Dr. Thomas Marin, DVM.  The survival laboratory staff coordinates closely with the minimally invasive urology team to facilitate research.  The facility is equipped with laparoscopic and endoscopic technologies as well as fluoroscopy.

Collaboration:  We have two PhD’s and a full time statistician in the Department of Urology. In addition, we collaborate with the Department of Biomechanical Engineering, Radiology and Physiology Departments.

For more information call Jaime Landman (212) 305-5630 or e-mail: landmanj@yahoo.com

PURPOSE OF POSITION: To provide a two (2) year long intensive and totally comprehensive program of minimally invasive oncology including Laparoscopy / Endourology / Robotics / Ablation / ESWL training in a unique learning environment for postgraduate, board eligible urologists who exhibit a desire to pursue an academic career in minimally invasive urology or who desire to specialize in this aspect of urology in a private practice setting. This two year fellowship is intended to provide the technical skills to perform advanced laparoscopic and endoscopic procedures as well as to develop the skills necessary to establish and run a minimally invasive urology laboratory.

Columbia University and the Department of Urology together have one of the best equipped clinical centers in the country for minimally invasive urology. With regard to laparoscopic surgery, Columbia University remains one of the most active centers in the country and has dedicated OR-1 (Storz) operating room space for laparoscopic surgery. Our operating theaters are equipment with the most up to date technology and often times includes prototypes that have been developed by or have been made specifically available for evaluation by our team.

With regard to basic endourology, New York Presbyterian Hospital a full service endourology center that incorporates three fully equipped cystoscopy suites. The equipment available for performing endourology includes the latest developments in endoscopy and lithotripsy. Currently available in these suites is a wide variety of flexible cystoscopes, flexible nephroscopes, and the latest and smallest rigid and flexible ureteroscopes, and the worlds most advanced digital technologies. In addition, all forms of intracorporeal lithotripsy are available including holmium laser. Furthermore, a wide variety of prototype instrumentation as well as clinical research equipment are available for use.

With regard to lithotripsy, we have a full time Dornie Doli 50 Lithotriptor in our dedicated endourology center. Although stone disease is not a sub-discipline of oncology, we have incorporated ESWL into the fellowship.

Robotic surgery is currently strongly emphasized in the Columbia University minimally invasive urology program due to its clear relevance in the future of all Urologic surgery.  We currently have a dedicated DaVinci robotic system which is very actively used by five full time faculty members for over 250 cases per year.  A second robotic system will soon be installed due to the rapidly increasing volume of cases. 

Ablation is clearly an important direction in minimally invasive urology.  The minimally invasive urology team has one of the world’s active clinical and research programs in cryoablation.  Dr. Aaron Katz directs the prostate cyroablation program and is one of the world’s leaders in this field.  Additionally, Dr. Landman performs a large volume of renal ablation, and the minimally invasive urology team continues to innovate in the technology and technique of renal ablation. 

At Columbia University, the minimally invasive urology group has a well funded and supported minimally invasive urology laboratory for both basic science and animal laboratory studies. A full time laboratory director is employed in the minimally invasive urology laboratory to facilitate the fellow in performing research studies, and the technicians and the veterinarians of the animal facility provide comprehensive animal care. Our laboratory and training facilities are located directly in the medical complex and thus are a short walk from the operating room to help coordinate our clinical and research activities. In addition, at any given time there are typically 1 to 3 international fellows who observe surgery and help facilitate the team’s research endeavors.  

The Columbia University minimally invasive urology team owes much of its success to collaboration with many other talented groups.  Indeed, we have a well developed collaboration with the minimally invasive team of the University of Texas – Southwestern and a fellowship exchange program for two week each year.  This is a rare opportunity for fellows to work with other very talented mentors to compare techniques and minimally invasive philosophies.  Additionally, we have active research collaboration with several groups including Drs. Ralph Clayman and Elspeth McDougal at the University of California – Irvine.

Finally, there are substantial ancillary facilities and support staff dedicated to the fellow. A personal computer, office space, and all appropriate networking facilities are provided to the fellow through the Columbia minimally invasive urology team. 

PRINCIPAL ACCOUNTABILITIES:

YEAR 1: BASIC/CLINICAL RESEARCH Upon the initiation of the fellowship the fellow is granted full attending privileges and is given the academic title of clinical instructor.  Approximately 60% of the time during this year is spent doing basic and clinical in minimally invasive urology. Each fellow will “inherit” a series of ongoing projects which the laboratory always has in progress.  Typically, one major project is assigned to the first year fellow.  This project is usually set in motion prior to arrival by the outgoing team, and will incorporate the incoming fellow’s particular area of interest(s). This project is designed and prepared such that it can be completed during the first year with a goal of providing data worthy of presentation and publication. Combining the primary project with ongoing projects, it is typical for the first year fellow to be primary author or co-author on between 5 and 10 peer reviewed publications. During this year, all laboratory supplies and additional needs would be provided through the laboratory. In addition, the laboratory has a full time lab director and dedicated technicians to help support the fellow in all research projects.  All laboratory projects are closely supervised by Dr. Landman. Laboratory meetings occur on a weekly basis (7am Tuesday mornings) to review progress and future directions; these meetings are attended by the entire faculty and staff of the minimally invasive urology team and typically last between 1.5 to 2 hours. Clinical responsibilities during the first fellowship year are purposely somewhat limited.  The fellow’s primary responsibility is to learn laparoscopic and endoscopic technique in the inanimate facility as well as while performing laboratory experiments.  However, as a team, we all share responsibility for all our team’s activity.  Due to our high clinical volume it is typical for the first year (laboratory fellow) to cover minimally invasive oncology cases when necessary.  

YEAR 2: CLINICAL FELLOWSHIP The major responsibility during this year is the clinical care of minimally invasive oncology patients at New York Presbyterian Hospital. The fellow will have active involvement in a wide range of laparoscopic, robotic and endourology procedures with Drs. Landman, McKiernan, Gupta, Badani, Katz, and Benson. The fellow shall act in a manner consistent with having sole responsibility for providing and coordinating all direct clinical care of Columbia University Department of Urology patients and shall work with the faculty and residents on minimally invasive oncology cases.  The fellow will also have his/her own clinic one half day per week at our affiliate hospital the Allan Pavillion.  Historically, the fellow has been able to generate a significant number of minimally invasive urology cases through this clinic which are initially scheduled with proper faculty support.  Later in the year, it is expected that the fellow will be able to perform the cases generated from his/her own clinic independently while teaching residents to perform these cases.

Responsibilities: The fellow will be expected to perform clinical duties in preparation for all cases he/she performs.  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 he/she were the primary physician.  The fellow will not have a formal call schedule, but will, by special request,  occasionally be expected to answer patient calls and follow patients in the hospital. During this year, it is anticipated that the fellow will be preparing manuscripts regarding the basic research completed during the initial year of the fellowship. In addition, ongoing or new clinical research protocols will likely be initiated, advanced, and/or completed. 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 fellow’s essay contest.  Graduation from the Columbia University minimally invasive urology fellowship will be contingent on obtaining Endourological Society credentialing.

TEACHING AND TRAINING: TRAINING, EDUCATION, EXPERIENCE, OR OTHER REQUIREMENTS: Candidates must be Board Eligible Urologists or have recently passed the FLEX exam with application made for Urology Board eligibility.

PHYSICAL DEMANDS: Must be able to assist in patient handling during emergencies and fulfill all of the duties outlined above.

VACATION AND EDUCATIONAL LEAVE POLICY: The fellow is required to notify, in written form, Dr. Landman, for of any period of absence whether due to vacation or educational leave. This is essential to insure the smooth operation of the Columbia University minimally invasive urology team. The fellow should make arrangements to have all of his/her responsibilities covered (eg. clinic, OR, and laboratory responsibilities.  With the exception of the annual meeting of the American Urological Association and the World Congress of Endourology, the two fellows may not be away at the same time.  The fellows must coordinate among themselves for all days off to prevent conflict. Educational leave shall be granted and not be counted as vacation if the fellow is either presenting the results of research or if he/she 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 Columbia University minimally invasive urology team will fund reasonable expenses for the endourology international meeting during the clinical fellowship year (second year) and for the annual AUA meeting during the research and clinical fellowship years.

SALARY: The fellows are paid through Columbia University as per their policies.  The annual fellowship salary is $55,000 per year.

ALL FELLOWS ARE EMPLOYEES OF COLUMBIA UNIVERSITY WITH BENEFITS PROVIDED THROUGH COLUMBIA UNIVERSITY

Jaime Landman, M.D. Director of Minimally Invasive Urology

For more information visit the Endourological Society Website