Alexander Beulens

33 The value of a 1-day multidisciplinary robot surgery training for novice robot surgeons Introduction Over the past years, much has changed for robot surgeons. Where the first robot surgeons received a short mandatory training in the basics of robotic surgery by the manufacturer, the next generation of robot surgeons has the possible advantage of a supervisor at their hospital to train them in their specific field of robotic surgery. Not all of these new robot surgeons do have access to the manufacturers basic training program since they are not necessarily new consumers of a robotic system. This could result in a gap in the training of residents and fellows since training of the basics of robotic surgery is currently not routinely implemented in their curricula. In 2010, the Dutch Health Care Inspectorate (IGZ) published a report stating ‘insufficient carefulness at the introduction of surgical robots’. In this report, the IGZ expressed its concern regarding robot-assisted laparoscopy. This report stated that in most hospitals, the criteria for novice robot-assisted laparoscopy were either vague or completely lacking.2,3 The lack of structured training, defined skill-criteria, and a systematic training needs analysis results in a personal training programme developed by the novice surgeons based on their own perceived lack of knowledge.4,5 This could result in a hiatus of knowledge due to overconfidence biases, an over-assessment of their own skill compared to the objective assessment of skill by an external observer6. To clarify criteria for starting robot-assisted surgery, the Netherlands Institute for Health Services Research (NIVEL) developed the ‘Basic proficiency requirements for the safe use of robotic surgery (BPR).7 As it was developed in co-operation with a surgeon, urologist, and a gynaecologist, these requirements transcend each of these individual disciplines and provide a guide to ensure each surgeon using a surgical robot has the required minimum of knowledge and skill to start preforming robot-assisted surgery.7 In earlier research, we investigated whether the current specialists think a basic training in robot surgery should be developed to guarantee a basic level of skills for all new robot surgeons.1 The majority of robot professionals in the Netherlands agree that the basics in robotic surgery should be learned in a structured training program to guarantee the quality of the surgeon and the safety of the patient. Since basic robot training could be similar for the different specialties such as general surgery, gynaecology, and urology a multidisciplinary basic robotic skills training could be a feasible and effective training method. To safeguard the quality the programme can be developed using the proficiency criteria defined by the NIVEL.1 Although several authors have investigated the development of a basic training in robotic surgery, no actual accepted basic robot surgery training has been implemented yet.8,9