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Training and outcome monitoring in robotic urologic surgery

Abstract

The use of robot-assisted laparoscopic technology is rapidly expanding, with applicability in numerous disciplines of surgery. Training to perform robot-assisted laparoscopic urological procedures requires a motivated learner, a motivated teacher or proctor, a curriculum with stepwise learning objectives, and regular access to a training robot. In light of the many constraints that limit surgical training, animal models should be utilized to quantifiably improve the surgical skills of residents and surgical fellows, before these skills are put into practice on patients. A system based on appropriate supervision, graduated responsibility, real-time feedback, and objective measure of progress has proven to be safe and effective. Surgical team education directed towards cohesion is perhaps the most important aspect of training. At present, there are very few published guidelines for the safe introduction of robotic urologic surgery at an institution. Increasing evidence demonstrates the effects of learning curve and surgical volume on oncological and functional outcomes in robotic surgery (RS). This necessitates the introduction of mechanisms and guidelines by which trainee surgeons can attain a sufficient level of skill, without compromising the safety of patients. Guidelines for outcome monitoring following RS should be developed, to ensure patient safety and sufficient baseline surgeon skill.

Key Points

  • The contemporary hospital environment has many constraints that limit surgical training; these pressures have modified the way in which surgical residents and fellows are trained

  • Training in a preclinical setting is important; this involves inanimate dry-lab practice with low-fidelity models, as well as animate or cadaveric robotic surgery

  • Systematic training in using a surgical robotic system on an animal model has been shown to result in a quantifiable improvement in surgical skills

  • Robotic skills training with appropriate supervision, graduated responsibility, real-time feedback, and objective measure of progress has proven to be safe and effective

  • Virtual reality simulators allow the trainee to achieve a high level of objectively measured skill before he or she is permitted to operate on a patient

  • Institutions must adopt guidelines for the safe introduction of robotic surgery to guarantee sufficient surgical skill level and ensure patient safety

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All five authors researched the data for the article, provided substantial contributions to discussions of the content, and reviewed and edited the manuscript before submission. D. Liberman, Q.-D. Trinh, C. Jeldres, and K. C. Zorn contributed to writing the article.

Corresponding author

Correspondence to Kevin C. Zorn.

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The authors declare no competing financial interests.

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Liberman, D., Trinh, QD., Jeldres, C. et al. Training and outcome monitoring in robotic urologic surgery. Nat Rev Urol 9, 17–22 (2012). https://doi.org/10.1038/nrurol.2011.164

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