Alexander Beulens

128 Chapter 4 ied significantly from an online training course developed by the manufacturer of the system to the requirement to pass all skills simulator exercises and participate in a standardized course at a training institute (i.e. ORSI academy). These results are in line with the results of Brinkman et al.3 and show there is a need for implementation of structured robot assisted surgery training during the residency. The implementation of a multi-step training and certification divided in online knowledge training, basic skills training (i.e. basic skills training, draping and docking, patient positioning, and general safety issues) and procedure-specific training could prepare the residents to safely take their first steps in robot assisted surgery thus reducing the risks for the patients.3 Most of the residents and almost half of the urologists agree robot assisted surgery training should be implemented in the residency of urologist. The advanced course in Robot Assisted Surgery A total of 29 participants with varying experience with both laparoscopic and robot assisted surgery completed the training curriculum. Results show most participants had extensive experience in laparoscopic surgery prior to the start of the training. The level of robot assisted surgery experience varied amongst participants, more than half of the participants had more than 10 hours of robot assisted surgery clinical experience as first surgeon prior to the start of the course of Robot Advanced Surgery. During the advanced course in Robot Assisted Surgery the dog and pig models were used. The dog cadaver is an excellent anatomical model because the dog’s prostate is quite similar to human regarding shape and size and the anatomical structures are easily recognizable. It is also good for training on constructing the urethro-vesical anastomosis. The length of its urethra, and the possibility to perform leakage-test, are important added values. Lymph nodes are easy detectable as they appear as agglomerated beans, clearly distinguishable from fatty tissue. A disadvantage of this dog cadaver model is absence of the seminal vesicles, and the absence of bleeding and peristalsis of the ureters. When the live-pig model is used, the life-threatening maneuvers must be carefully avoided. This makes the training on the pig model more challenging and closer to real surgery compared to the dog model. The live-pig model, in comparison to the cadaver-dog model, presents large seminal vesicles which permits proper dissection training. However, it also presents disadvantages. The prostate gland is tiny, and its shape is different in comparison to the human one. For this reason, the prostate dissection in the pig is less didactic than in the dog model. Moreover, a leakage test cannot be performed because of the impossibility to insert a catheter. Lastly, the pig’s bladder must be repeatedly and carefully emptied to avoid urine leakage and reabsorption. Excessive reabsorption of urea can result in the animal’s death.