I have taken the initiative coupled with the Pediatric and Adolescent Comparative Effective Research (PACER) to compare robotic and open pediatric surgery.  I was awarded a NIH R21 grant in 2015 titled: Randomized Robotic-Assisted versus Open surgery: Benefits and Patient Centered Outcomes Trial (Randomized ROBOT) to perform a feasibility trial and identify patient centered outcomes.  A secondary focus is to determine possible approaches to improve patient enrollment into randomized controlled trials, particularly in the pediatric population.  My future research plan is to apply for a R01 grant comparing robotic versus open pediatric pyeloplasty, to hope to determine at what age robotic surgery should be offered in the pediatric population.  Furthermore, to extrapolate this research design to other common pediatric urology procedures, such robotic versus open ureteral reimplantation.

As director of pediatric urology robotic surgery, I am responsible for the education of IU urology residents and fellows with respect to pediatric robotic surgery.  During intraoperative instruction, I became interested in robotic suture manipulation and if it had correlation with robotic surgery proficiency.  I subsequently submitted and was awarded an industry sponsored grant to determine if suture manipulation could be correlated with robotic surgery proficiency.  This grant is ongoing but clearly demonstrates that robotic naïve urologic trainees damaged suture significantly more then robotic surgical experts.  This research project as it evolves should provide an objective measure to assess robotic proficiency, which may be included in surgeon assessment prior to being granted robotic surgery privileges. 

The sacral neuromodulation procedure has provided tremendous impact on patient and family quality of life; future directions include randomization to sacral neuromodulation versus tethered cord release as well as further expansion into new clinical realms.  Current research avenues include quality of life assessment and creating protocols to reduce neuromodulator use and provide a route for cure.  This specialized clinic has also fostered other avenues of research in the field of voiding dysfunction.  I am currently running two exciting research projects: (1) scheduled awaking for refractory nocturnal enuresis and (2) assessment of voiding dysfunction clinical utilities.  Both of these projects are gathering preliminary data and have potential for grant funding. 

At Riley Hospital for Children I have built a pediatric urology robotic surgery program.  Over the last three years our robotic surgical volume has increased to over 50 cases per year, placing us in the top ten pediatric robotic urology programs in the country.  As the pediatric urology robotic program grows, other divisions have begun to develop an interest, resulting in an expansion of the robotic pediatric program.  I plan to expand the pediatric urology robotic surgery to include more complex surgical procedures and use new robotic techniques (single site technology).

At Riley Hospital for Children I have pioneered the use of sacral neuromodulation to treat refractory voiding dysfunction in the pediatric population.  These pediatric patients have failed all therapy and continue to have significant urinary problems resulting in significant parental and patient distress.  I have performed over 60 sacral neuromodulation procedures, making us one of the top institutions in country.  After starting to perform these procedures, it became evident a specialized clinic was necessary to evaluate and care for these complicated patients both pre and post procedure.  As director of this refractory voiding dysfunction clinic, we evaluate 4-5 new patients per month and follow-up on an additional 5-10 postoperative patients.