Alexander Beulens

113 Structured robot-assisted surgery training curriculum for residents in Urology and impact on future surgical activity Introduction The introduction of robotic-surgery dramatically changed the approach to the patient with urologic pathologies over the last decade.1–7 Initially, the novice robotic surgeon was receiving a short compulsory course in the basics of robotic surgery by the manufacturer. Nowadays the next generation of robotic surgeons have many opportunities to learn robot assisted surgery (RAS) before operating on patients. Indeed, many training methods are available including the possibility of mentoring by an expert surgeon during the initial phase of the learning curve. A basic robotic surgery training with “the introduction to the robotic system” is usually provided by the manufacturer to surgeons starting with RAS. However not all the novice robotic surgeons have access to this basic training programme which could result in a serious gap of knowledge. The Dutch Healthcare Inspectorate (IGJ) published a report in 2010 entitled ‘Inadequate preparation in the introduction of surgical robots.’ This reports states that the starting criteria were undefined for autonomously performing robotic surgery and advocates education, proven capability and competency for ‘robotic surgeons’.2,8 The lack of a structured curriculum and a defined set of skill-criteria during the residency program, results in an unofficial not certified training based on the own perception of knowledge and surgical skills acquired by the novice surgeon.9–11 This results in a burden of non-standardized training pathways that can differ significantly from trainee to trainee.12,13 Indeed previous research has shown that novice robotic surgeons are unable to accurately self-assess their skills.12 Based on the results of this study the objective assessment of dexterity and surgical skills should be included and the results discussed with the trainees to identify the need of further training accordingly to the progress of the trainee.12 In earlier research, we investigated whether the current specialists agreed that a basic training in to guarantee a basic level of skills for all new robot surgeons.3 The majority of robot professionals in the Netherlands agreed that robotic surgery should be learned in a structured training program to guarantee the surgical quality and safety to the patient.3 In a recent study by the group of Satava et al, a randomized controlled trial was performed amongst inexperienced surgical trainees.14 This study showed that a well-structured curriculum where threshold scores are used to assess the participants (up to proficiency levels) resulted in a better performance on the avian tissue model (transfer test) compared to the control group which was trained without a structured training. This showed that a structured training program is able to contributes significantly to surgical skills of novice robot surgeons.14