Description of the Robotic, Minimally Invasive, and Endourological Fellowship

University of Pennsylvania

Perelman School of Medicine

Department of Surgery

Division of Urology

Materials Required for Application

The Endourology Fellowship match is run in partnership with the AUA. The Penn Minimally Invasive, Robotics, and Endourology Fellowship participates in the Endourological Society/AUA Match.

https://www.pennmedicine.org/departments-and-centers/department-of-surgery/education-and-training/fellowships/robotics-and-endourology-fellowship

Before applying please ensure you meet the following criteria:

1. You must be a United States citizen or legal permanent resident to apply for a fellowship in our program. Unfortunately, international or foreign citizens are not eligible to apply for a fellowship in our program.
   1. You must be authorized to live and work in the United States. Sponsorship or filing of an immigrant petition (permanent) or a nonimmigrant petition (temporary) for a prospective (fellow) employee, such as through a J-1 exchange visitor program will not be possible. All foreign nationals should confirm their current visa allows them to live and work in the United States prior to submitting a fellowship application.
2. You must have completed a nationally approved and accredited United States urology residency program to apply for a fellowship.
3. You must be eligible to obtain a Pennsylvania State Medical License to apply for a fellowship. The full criteria can be found at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/Physician-Surgeon-Licensure-Requirements-Snapshot.aspx

To apply:

1. Register for the Endourological Society Match at https://medmatch.auanet.org/
2. Send a copy of their complete application as a single PDF, except for letters of recommendation, which can be sent individually, if necessary, to Gretchen Harz, Coordinator of Medical Education for the Division of Urology at This email address is being protected from spambots. You need JavaScript enabled to view it.. This should include:
   1. A completed Endourological Society Match Application, which is available at https://www.endourology.org/fellowships
   2. A current Curriculum Vitae.
   3. A personal statement outlining your qualifications and how participating in this fellowship program fits into your future career goals and plans. Please limit this to 750 words or less.
   4. A total of 3 letters of recommendation with 1 from your urology residency Program Director.
3. Send an additional copy of their complete application to Debra Caridi, Endourological Society Fellowship Coordinator at This email address is being protected from spambots. You need JavaScript enabled to view it..

A complete application must be received by our office via email by Tuesday, April 1st 2025 at 5 PM Eastern. Any applications received after this deadline will not be considered.

A single virtual interview date will be scheduled in May, 2025. Applicants invited to interview will receive details directly.

Introduction:

The Penn Urology Minimally Invasive Fellowship is one of the longest standing endourology fellowships in the country having continuously trained a fellow since 2005. In our program, you will be fully integrated into the clinical, academic, and educational mission of Penn Urology. Penn Urology is one of the highest volume and acuity academic urological practices in the country with 3 tertiary care hospitals. Your training will involve practice-based learning from our faculty of all fellowship-trained, high-volume surgeons in the areas of endourology/robotics, oncology, and female pelvic medicine and reconstructive surgery. In addition to the rich clinical experience, you will be mentored in scholarly activities with opportunities for involvement in funded clinical trials, health services research, clinical outcomes studies, education/simulation, and quality improvement. Finally, you will participate in the training, education, and mentorship of our resident and medical students. We believe that this rich and diverse educational experience we have structured for you develops urologists who go on to lead in community and academic urology. We hope that you will consider us for your advanced training.

Goals and Objectives

Our goal is to train leaders in minimally invasive and endoscopic urology both in community and academic practice. To achieve this goal, we have the following educational objectives:

1. To demonstrate advanced and mastery knowledge in the pre- and post-operative evaluation of diseases of the urinary tract commonly treated with minimally invasive and endoscopic techniques, which are often, but not limited to prostate cancer, renal cell carcinoma, bladder cancer, complex urinary stones, ureteropelvic junction obstruction, and pelvic organ prolapse.
2. To develop advanced and mastery knowledge in the surgical equipment and techniques of minimally invasive and endoscopic surgery, which are often, but not limited to robotic prostatectomy, robotic partial/radical nephrectomy, robotic radical cystectomy, robotic pyeloplasty, robotic sacrocolpopexy, percutaneous renal access, percutaneous nephrolithotomy, and ureteroscopy with lithotripsy.
3. To demonstrate advanced and mastery ability in managing the continuity of care for a panel of patients from ambulatory consultation to pre-operative visit to operative intervention to post-operative visit to long-term surveillance.
4. To develop a foundation or advanced skill in research design, implementation, and analysis.
5. To identify systems issues in process, safety, and quality, and actively work to improve these areas.
6. To strengthen a pattern of behavior consistent with self-directed and life-long learning.
7. To be devoted to the teaching of peers and colleagues.

Curriculum

The fellow will be primary based at the Hospital of the University of Pennsylvania. This is the flagship acute care hospital and primary academic teaching site within the University of Pennsylvania Health System. It also serves as a quaternary referral center for the larger Mid-Atlantic region. This is home to our cancer center and complex urinary stone program. It is common to see patients referred from all the country and world to have robotic surgery. Here the fellow will join either Dr. Thomas J. Guzzo or Dr. Daniel Lee with their robotic oncology cases, primarily focusing on robotic prostatectomy and robotic partial and radical nephrectomy. There is also opportunity to gain experience with single port robotic benign and oncology cases with Dr. Benjamin Schurhamer. These opportunities will occur approximately 1-2 times per week. In addition, the fellow will join Dr. Justin B. Ziemba for his percutaneous nephrolithotomy cases where there will be instruction in renal access. In addition, there will be opportunities for participation in other complex, large volume ureteroscopic stone cases. This will be approximately 1 time per week. 

The fellow will also have an opportunity to operate at Pennsylvania Hospital. It is the Nation’s first hospital. This is in the heart of the historic Philadelphia district and a short drive from the other 2 hospitals. It is a community-based hospital, but increasingly seeing complex urological cases, particularly robotic upper urinary tract and pelvic reconstruction. The fellow will also spend time with Dr. Phillip Mucksavage who has a robust robotic oncologic surgery practice. He is also busy with complex stone disease, which will be another opportunity to gain training in percutaneous nephrolithotomy with renal access. There is also an increasing emphasis on robotic upper urinary tract reconstruction at Pennsylvania Hospital with support from faculty member and reconstructive expert Dr. Robert Caleb Kovell. This is also home to our female pelvic medicine and reconstructive surgery and voiding dysfunction program. Here the fellow will operate with Dr. Ariana L. Smith for robotic pelvic and reconstructive surgery. Operating at Pennsylvania Hospital will be approximately 1 time per week.

Finally, the fellow will also operate at Penn Presbyterian Medical Center, which is only a few blocks from the Hospital of the University of Pennsylvania. This is a tertiary referral center for the tristate area. It is home to our high-volume oncologic robotic surgery program, including RPLND. However, it is also a primary site for community-based urology for the surrounding West Philadelphia and University City population. The fellow will be join with Dr. Phillip M. Pierorazio and Dr. Daniel Lee in his operative cases approximately 1 time per week.

In the operating room, the fellow will have primarily console time as the tableside assistants are dedicated PA. Minimal tableside assisting will be performed in the early part of the training to ensure competency in this important aspect of the procedure. 

In addition, there will be continuity fellow’s clinic approximately 1 time every other week as well as your own dedicated half day afternoon operating room time to schedule cases from clinic. This will provide you with a guided and mentored opportunity to build confidence, skill, and organization in managing your own practice.

Combined our faculty will perform nearly 1000 robotic cases per year across the range of subspecialties. In addition, our faculty will perform nearly a total of 120 percutaneous nephrolithotomy and 600 ureteroscopic cases per year for complex stone disease. This volume and breadth is unmatched with other fellowship programs.

Finally, it is our expectation that this will be a 1 year combined robotics/laparoscopic and endourology fellowship. However, should you prefer focusing on one area of expertise over another, then we can make appropriate adjustments and accommodations within the guidelines set forth by the Endourological Society for accreditation to be sure that your fellowship experience matches your preferred learning. To that end, we are now one of the few fellowship programs who have received approval to offer the new Minimally Invasive Urologic Oncology program from the Endourological Society.

Sample Weekly Schedule

Week 1

Week 2

Week 3

Week 4

*HUP-Hospital of the University of Pennsylvania

*PPMC-Presbyterian Medical Center

*PAH-Pennsylvania Hospital

Evaluation Methods

The fellow is expected to participate fully and faithfully in their clinical and research duties. The fellow will receive at least monthly feedback on his/her progress pertaining to surgical skill acquisition and patient management. This evaluation is performed as part of the standard protocol for all surgical fellowships within the Department of Surgery at the University of Pennsylvania.

The fellows are allowed autonomy in a graded fashion. This occurs through a mastery learning model. In this model, for example, in a robot prostatectomy case, the fellow is expected to perform a predefined section of the procedure, such as developing the space of Retzius until this portion is performed in a proficient manner. Once this step is mastered, then the fellow is advanced to the next step in the progression. We believe that this model allows for immediate, actionable, and specific feedback to ensure mastery of a technical skill.

Fellowship Faculty

Program Directors:

Justin B. Ziemba, MD, MSEd

Philip Mucksavage, MD

Preceptors:

Phillip M. Pierorazio, MD

Benjamin Schurhamer, MD

Thomas J. Guzzo, MD, MPH

Daniel J. Lee, MD, MS

Justin B. Ziemba (Fellowship Program Director):

Justin B. Ziemba, MD, MSEd attended the Perelman School of Medicine at the University of Pennsylvania, earning his medical degree in 2010. He stayed at the University of Pennsylvania to complete his general surgery internship and urologic surgery residency at the Hospital of the University of Pennsylvania in 2015. Following his residency, he spent 2 years as a clinical and research fellow in minimally invasive surgery and endourology at the James Buchanan Brady Urological Institute of the Johns Hopkins Hospital and Instructor of Urology at the Johns Hopkins School of Medicine.

He routinely performs approximately 60 percutaneous nephrolithotomy per year, gaining his own access in the operating room, and over 300 ureteroscopy per year. This makes him one of the highest volume kidney stone surgeons in the area. He also performs comprehensive metabolic evaluation and prevention counseling. He works closely with a team of nephrologists in the Kidney Stone Evaluation Center to co-manage some of the most complex kidney stone patients in the region. He trained under one of the most prolific and well-respected endourologists, Dr. Brian Matlaga.

Phillip Mucksavage (Associate Fellowship Program Director)

Dr. Phillip Mucksavage, MD is the Director of Endourology/Stone Disease at Pennsylvania Hospital. He is an endourologist who completed his endourology fellowship under Drs. Clayman and Ahlering at UCI Medical Center. He performs a wide variety of robotic procedures including radical prostatectomy, radical/partial nephrectomy, and reconstruction of the upper urinary tract. He also has robust complex urinary stone practice. Similar to Dr. Ziemba above he also routinely performs approximately 60 percutaneous nephrolithotomy per year, gaining his own access in the operating room, and over 300 ureteroscopy per year. He also performs comprehensive metabolic evaluation and prevention counseling. He too works closely with a team of nephrologists in the Kidney Stone Evaluation Center to co-manage some of the most complex kidney stone patients in the region.

Phillip M. Pierorazio (Chief, Section of Urology, Penn Presbyterian):

Dr. Phillip M. Pierorazio, MD is a urologist specializing in minimally invasive urologic oncology. He is a nationally and internationally recognized expert in small renal mass treatment, including the surveillance and non-operative management. Similarly, he is equally as well known for the minimally invasive management testes cancer, including robotic RPLND.

Thomas J. Guzzo (Chief of the Division of Urology):

Dr. Tom J. Guzzo, MD, MPH is the Chief of the Division of Urology. He completed his fellowship in urologic oncology at John Hopkins Hospital. He is one of the busiest urologic oncologists in Pennsylvania. He performs about 400 robotic oncology cases per year including prostates, kidneys and bladder.

Daniel J. Lee:

Dr. Daniel J. Lee, MD, MS is a urologic oncologist having finished his urologic oncology fellowship at Vanderbilt University. He performs primarily robotic oncology cases including prostates, kidneys and bladders.

Benjamin Schurhamer:

Dr. Benjamin Schurhamer, MD is an endourologist having finished his endourology fellowship at the University of Pennsylvania. He performs primarily robotic oncology cases including prostates, kidneys and bladders. He is also pioneering our single-port robotic surgery and focal therapy programs.

Research Experience

The fellow will be mentored in scholarly activities with opportunities for involvement in clinical trials, health services research, clinical outcomes studies, education/simulation, and quality improvement, depending on interests. Fellows will be encouraged to engage in these projects as a framework in which to learn and expand their research skills, build their research portfolio, and develop a foundation for later funded or independent research/scholarship. We expect the fellows to publish their work as well as present their findings at international, national, and regional scientific meetings.

We have several privately and federally funded research projects currently on-going, which provides a rich environment. There is protected research time built into the monthly schedule to ensure that there is ample opportunity to participate in these research projects and complete meaningful and quality work.

We have dedicated research staff to perform database management and maintenance, obtain patient consent, and regulatory duties required from the IRB and FDA. We have ongoing collaborations with our departments in medical oncology, pathology, radiology, radiation oncology, bioengineering (specifically robotics), and biostatistics.

Finally, the University of Pennsylvania is rich in academic opportunity. Fellows who are interested in health economics and health policy are encouraged to join the Leonard Davis Institute of Health Economics. There are also opportunities for innovation or to participate in quality improvement or patient safety through the Center for Healthcare Improvement & Patient Safety. Penn Medicine also has a state of the art and robust clinical simulation center with robotic, laparoscopic, and percutaneous trainers which can be used for educational research.