Chakroborty Fellowship 2009
Report of Dr. L.N. Dorairajan, Professor of Urology, JIPMER, Puducherry, India
I am indeed grateful to the Indian American Urological Association for awarding me the
Chakroborty Fellowship for the year 2009. My objective of the fellowship was to acquire an
insight into advanced laparoscopic and robotic assisted urological surgery with special focus
on urological oncology. Accordingly I looked for placements in such institutions well known
in these fields. I was fortunate to do my fellowship under Prof. Ashok Hemal, Director of
Robotics and Minimally Invasive Urology in the Department of Urology, Wake Forest
University Baptist Medical Center (WFUBMC), Wake Forest University of Health Sciences,
Winston Salem, North Carolina from 15 March 2009 to 24 April 2009 and under
Dr.Harcharan Gill, Associate Professor of Urology and Program Director, Department of
Urology at the Stanford School of Medicine, Palo Alto, California from 1 May 2009 to 31
May 2009. I attended the Indian American Urological Association annual meet on 25 April
2009 followed by the American Urological Association annual meet in Chicago, Illinois from
25 April 2009 to 30 April 2009.
Fellowship at the Wake Forest University School of Medicine - The Baptist Medical
Wake Forest University Baptist Medical Center is one of USA’s preeminent academic
medical centers that also provides comprehensive health care to the people of the region. The
Medical Center is a well known tertiary care referral center in the region but through its
affiliate hospitals and satellite clinics it also provides primary care as well as outpatient
rehabilitation, dialysis and home health care services.
The Medical Center consists of two main hospitals- the North Carolina Baptist Hospital
(NCBH) which is an 872-bed teaching hospital and the region’s main tertiary care referral
center and the Brenner Children’s Hospital which is a 160 bedded comprehensive pediatric
services that has the region’s only Pediatric Emergency Department and the region’s only
level IV neonatal intensive care unit. The center is recognized by the National Cancer
Institute as a Comprehensive Cancer Center that houses the latest technologies for the
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treatment of cancer patients. The Department of Urology is a part of the NCBH and its
clinical office is located at 140 Charlois Boulevard, in Winston-Salem.
I arrived in Winston -Salem North Carolina on 15 March 2009. Dr. Hemal was very kind and
received me at the airport. He took me to the apartment he had arranged for me. He then
explained the academic schedule he had planned for the six weeks I was to spend with him. I
went through a formal orientation program of the WFUBMC on 16 March and thereafter
spent my time in the Urology Department. Prof. Hemal introduced me to Prof. Anthony
Atala, Chairman of the Urology Department and Director, Institute of Regenerative Medicine
and to all the other faculty members of the department.
I spent most of my time in the operating rooms observing the experts perform various
operations. Prof. Hemal demonstrated several cases of laparoscopic as well as robot assisted
laparoscopic procedures. He explained to me the steps of the procedure in great detail. Dr.
Karim Kader, a uro-oncologist and specialist in robotic surgery, demonstrated several cases
of robotic assisted laparoscopic radical cystectomy with ileal conduit diversion. Dr. Joseph
Pettus, a specialist in urologic oncology, demonstrated many procedures like partial
nephrectomy and nerve sparing retroperitoneal lymph node dissection for testicular cancer. I
also observed several procedures for urinary incontinence and erectile dysfunction like
implantation of different types of penile prosthesis and artificial urinary sphincter by Prof.
Gopal Badlani and Prof. John Smith. Prof. Dean Assimos, a world renowned authority in the
management of urolithiasis and endourology demonstrated percutaneous antegrade as well as
ureteroscopic retrograde stone retrieval procedures using different types of flexible and rigid
endoscopes and a variety of intracorporeal lithotripters like Cyberwand, Ho: YAG laser, and
the Lithoclast Master. Prof. Gordon McLorie, Head, Section of Pediatric Urology and Dr.
Steve Hodges showed many pediatric urologic procedures
I observed over 70 surgical procedures including 10 robot assisted laparoscopic radical
prostatectomy. The following is a complete list of surgical procedures that I observed at the
Wake Forest University Baptist Medical Center:
1. Laparoscopic surgery: radical, donor and simple nephrectomies.
2. Robot assisted laparoscopic surgery: radical prostatectomy, simple nephrectomy, partial
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3. Surgery for urinary incontinence: Implantation of artificial urinary sphincter, male and
female urethral sling surgeries and augmentation cystoplasty.
4. Surgery for erectile dysfunction: implantation of inflatable and malleable penile
4. Oncologic surgery: open partial nephrectomies.
5. Endourological surgery; percutaneous nephrolithotomy, retrograde intrarenal surgery and
ureteroscopic lithotripsy including the use of holmium laser, Cyberwand and flexible
ureteroscopes and nephroscopes.
6. Bipolar (saline) TURP and TURT with plasma kinetic energy (Gyrus Superpulse).
I also saw several urodynamic and video urodynamic studies and the organization of urology
I attended the academic programs of the department including journal presentations, case
discussions, faculty presentation and morbidity and mortality meet. Once a month there was a
presentation by a faculty invited from other departments of WFUBMC or other Institutions.
The visit to the regenerative medicine laboratory was a very interesting and enlightening
experience. Dr. Victoriano Romero, a urology resident, showed me around the laboratory.
The lab has over one hundred research workers working on a wide rage of research projects. I
saw some very interesting gadgets like the cell printer and some of the techniques used in
skin expansion and regeneration.
All the faculty members took pains to make my visit fruitful and comfortable. They discussed
their clinical experiences and explained their techniques and answered whatever questions I
had on various aspects of urologic care. They also ensured that I had a good experience of not
only urology but also of at some aspect of the US life and culture. Prof. Hemal invited me to
attend the Winston –Salem Symphony orchestra. He also took me to a couple of films in the
theatre. I attended the Indo-US Cultural Society picnic on the occasion of Holi. Prof. Assimos
invited me to a dinner with his family and Prof. Badlani also hosted a dinner. The whole visit
was a highly fulfilling academic and social experience.
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The IAUA and the AUA meeting at Chicago
I attended the IAUA annual meet on 25 April 2009 in Chicago and presented a paper on
“Clinical Profile and Management of Urethral Stricture Disease Seen in South India” in the
“Young Urologist Forum” of the meeting. All the presentations in this meeting were very
interesting and extremely useful. I attended the IAUA banquet that evening and was
presented with the Chakroborty Fellowship award at the prize distribution ceremony. The
banquet gave me an opportunity to interact with several eminent urologists of Indian origin in
the USA. The next five days I attended the different sessions of AUA meet. The insight into
the latest progress in basic science research, the new innovations and the technological
developments in urology made this an extremely rewarding experience. I met Dr. Harcharan
Gill, Associate Professor of Urology, Stanford University School of Medicine at the AUA
meet. He gave an overview of the academic schedule that he had planned for me.
Fellowship at the Stanford University School of Medicine
The Stanford School of Medicine is an integral part of a vibrant university that includes other
world-renowned educational institutions like the schools of Business, Law, Earth Sciences,
Education, Engineering, and Humanities & Sciences. These institutions share the same
campus and a number of facilities like the lecture auditoriums, research labs and many other
amenities like the cafes, gyms, bike paths, museum exhibits, music halls etc.
The School of Medicine which is a part of the prestigious Stanford Medical Center located in
the campus. Its has many affiliated hospitals that include the hospital and clinics of the
Stanford Medical Center as well as nearby Palo Alto Veterans Affairs Health Care System
and county medical facilities. The faculty and research scholars in the school of medicine are
involved in in some of the country’s top biomedical research programs. The hospitals of the
Stanford Medical Center are the Stanford Hospital and Clinics which is an advanced tertiary
care referral center as well as a Level 1 trauma center with about 900 beds and the Lucile
Packard Children’s Hospital, a 272 bed hospital that renders comprehensive care to children
and expectant mothers. The Advanced Medical Center of the Stanford Hospital houses the
Urologic Oncology Division of the Department of Urology.
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I continued my fellowship in the Urologic Oncology Division of the Department of Urology
at the Stanford University School of Medicine, California under Dr. Harcharan Gill. Dr. Gill
received me warmly and helped me complete the formalities of registration. He then
introduced me to the chair, Prof. Joseph Presti and to his colleagues Dr. James Brooks and
Dr. Benjamin Chung in the Urologic Oncology Division. He also showed me the operating
rooms, the clinic, the ward, the conference rooms for academic programs and the library so
that I could settle down quickly. I spent most of my time in the operating rooms observing
predominantly laparoscopic surgeries and robotic surgeries performed by Dr. Gill and Dr.
Chung. Dr. Chung explained in detail the different techniques that he uses in performing the
laparoscopic procedures and ways of overcoming various difficulties. I also saw a number of
open oncologic surgeries demonstrated by Prof. Joseph Presti and Dr. James Brooks. The
faculty members took great interest in demonstrating the nuances of the procedures. They
were very eager to teach and share the wealth of clinical experience that they possessed. They
answered the many questions that I asked which greatly helped my understanding of the
subject. I had the opportunity to discuss with these eminent and experienced urologists
various issues pertaining to surgical techniques as well as other difficult clinical problems
that I had encountered in India.
During my stay I observed the following operations:
1. Open nerve sparing radical prostatectomy
2. Open radical cystectomy with ileal conduit diversion as well as orthotopic neobladder
3. Laparoscopic partial nephrectomy
4. Laparoscopic radical nephrectomy
5. Robot assisted laparoscopic radical prostatectomy.
I participated in the various academic programs including the indications conference, faculty
presentations, journal presentations and the morbidity and mortality discussion sessions. I
also had the good fortune of attending a lecture by a visiting faculty from the Washington
University School of Medicine, Dr. Sam Biyani, on robotic assisted laparoscopic partial
Dr. Gill arranged for a visit to the research laboratories of the department and I got an insight
into the advanced research in oncology being performed by the department. Dr. Gill also took
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me to the surgical simulation laboratory where surgical and urology resident train before
assisting in surgical procedures on patients.
I cannot forget the many tours around the Stanford campus that Dr. Gill took me around and
it was very interesting to see the lovely campus and the amazing research infrastructure. This
combined with the highly eminent faculty that the institution attracts from all over the world
has made this institution one of the best in the world. Dr. Gill hosted a dinner and introduced
me to his family. It was traditional Indian style dinner with all its warmth and hospitality. He
gave me a number of ideas for strengthening collaborative work in research areas as well as
in areas of training of resident doctors. He also gave me a lot of ideas on developing
laparoscopic urology in my institution.
I learnt a lot from fellowship in these two institutions. Besides learning surgical procedures I
had a good exposure to the use of many advanced medical equipment like the Gyrus
Superpulse bipolar electrosurgical generator for saline TUR, the use of GI staplers, high
definition endovision camera systems, digital ureteroscopes, intraoperative ultrasound (used
during during laparoscopic partial nephrectomy), various surgical instruments used in the
I returned to India on 6th of June after spending a few days in sight seeing in the US. My
fellowship would not attain its true value unless the experience gained can be translated into
tangible benefits for my institution. I propose to use the valuable experience that I have
gained in my institution and some of the ideas that I intend to put into practice immediately
1. Start some of the minimally invasive procedures like laparoscopic partial
nephrectomy and pyeloplasty as well as open procedures like sling surgeries for male
and female incontinence.
2. Put to effective use the technical points I learnt in performing nerve sparing open
radical prostatectomy as well as radical cystectomy.
3. Share the knowledge and experiences with the post graduate students in my
4. Expand the range of office procedures being performed.
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5. Explore possibilities of collaborative research and develop exchange programs for
residents in training.
I have already performed laparoscopic nephrectomy successfully, started videourodynamic
studies and incorporated routine check nephroscopy with a flexible nephroscope in PNL since
I returned to my institution. I hope to put to good use the experience that I have gained
through my fellowship in many the other fronts as well. I once again thank the IAUA for
providing me this opportunity of a life time that has widened my knowledge and experience
of the science and art of urology.
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