Current Urology Reports

, Volume 11, Issue 2, pp 87–92 | Cite as

Residency Training Program Paradigms for Teaching Robotic Surgical Skills to Urology Residents

  • Sonal Grover
  • Gerald Y. Tan
  • Abhishek Srivastava
  • Robert A. Leung
  • Ashutosh K. Tewari
Article

Abstract

The advent of laparoscopic and robotic techniques for management of urologic malignancies marked the beginning of an ever-expanding array of minimally invasive options available to cancer patients. With the popularity of these treatment modalities, there is a growing need for trained surgical oncologists who not only have a deep understanding of the disease process and adept surgical skills, but also show technical mastery in operating the equipment used to perform these techniques. Establishing a robotic prostatectomy program is a tremendous undertaking for any institution, as it involves a huge cost, especially in the purchasing and maintenance of the robot. Residency programs often face many challenges when trying to establish a balance between costs associated with robotic surgery and training of the urology residents, while maintaining an acceptable operative time. Herein we describe residency training program paradigms for teaching robotic surgical skills to urology residents. Our proposed paradigm outlines the approach to compensate for the cost involved in robotic training establishment without compromising the quality of education provided. With the potential advantages for both patients and surgeons, we contemplate that robotic-assisted surgery may become an integral component of residency training programs in the future.

Keywords

Robotic Prostatectomy Training Education 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Box GN, Ahlering TE: Robotic radical prostatectomy: long-term outcomes. Curr Opin Urol 2008, 18:173–179.CrossRefPubMedGoogle Scholar
  2. 2.
    Tewari A, Srivasatava A, Menon M: A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003, 92:205–210.CrossRefPubMedGoogle Scholar
  3. 3.
    Duchene DA, Moinzadeh A, Gill IS, et al.: Survey of residency training in laparoscopic and robotic surgery. J Urol 2006, 176:2158–2166.CrossRefPubMedGoogle Scholar
  4. 4.
    Menon M: Robotic radical retropubic prostatectomy. BJU Int 2003, 91:175–176.CrossRefPubMedGoogle Scholar
  5. 5.
    Lotan Y, Cadeddu JA, Gettman MT: The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 2004, 172:1431–1435.CrossRefPubMedGoogle Scholar
  6. 6.
    Mouraviev V, Nosnik I, Sun L, et al.: Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience. Urology 2007, 69:311–314.CrossRefPubMedGoogle Scholar
  7. 7.
    Bolenz C, Gupta A, Hotze T, et al.: Cost comparison of robotic, laparoscopic and open radical prostatectomy. Eur Urol 2009 Nov 11 (Epub ahead of print).Google Scholar
  8. 8.
    Menon M, Tewari A, Baize B, et al.: Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 2002, 60:864–868.CrossRefPubMedGoogle Scholar
  9. 9.
    • Steinberg PL, Merguerian PA, Bihrle W 3rd, et al.: The cost of learning robotic-assisted prostatectomy. Urology 2008, 72:1068–1072. The authors have meticulously studied the major challenges in establishing a robotics training program. CrossRefPubMedGoogle Scholar
  10. 10.
    Patel VR, Tully AS, Holmes R, et al.: Robotic radical prostatectomy in the community setting-the learning curve and beyond: initial 200 cases. J Urol 2005, 174:269–272.CrossRefPubMedGoogle Scholar
  11. 11.
    Mayer EK, Winkler MH, Aggarwal R, et al.: Robotic prostatectomy: the first UK experience. Int J Med Robot 2006, 2:321–328.PubMedGoogle Scholar
  12. 12.
    Bentas W, Wolfram M, Jones J, et al.: Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol 2003, 44:175–181.CrossRefPubMedGoogle Scholar
  13. 13.
    Bhandari A, McIntire L, Kaul SA, et al.: Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 2005, 174:915–918.CrossRefPubMedGoogle Scholar
  14. 14.
    Wolfram M, Brautigam R, Engl T, et al.: Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique. World J Urol 2003, 21:128–132.CrossRefPubMedGoogle Scholar
  15. 15.
    Ahlering TE, Skarecky D, Lee D, et al.: Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003, 170:1738–1741.CrossRefPubMedGoogle Scholar
  16. 16.
    Mikhail AA, Orvieto MA, Billatos ES, et al.: Robotic-assisted laparoscopic prostatectomy: first 100 patients with one year of follow-up. Urology 2006, 68:1275–1279.CrossRefPubMedGoogle Scholar
  17. 17.
    Menon M, Shrivastava A, Tewari A, et al.: Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002, 168:945–949.CrossRefPubMedGoogle Scholar
  18. 18.
    Herrell SD, Smith JA Jr: Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 2005, 66:105–107.CrossRefPubMedGoogle Scholar
  19. 19.
    Rashid HH, Leung YY, Rashid MJ, et al.: Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 2006, 68:75–79.CrossRefPubMedGoogle Scholar
  20. 20.
    Thiel DD, Francis P, Heckman MG, et al.: Prospective evaluation of factors affecting operating time in a residency/fellowship training program incorporating robot-assisted laparoscopic prostatectomy. J Endourol 2008, 22:1331–1338.CrossRefPubMedGoogle Scholar
  21. 21.
    • Link BA, Nelson R, Josephson DY, et al.: Training of urologic oncology fellows does not adversely impact outcomes of robot-assisted laparoscopic prostatectomy. J Endourol 2009, 23:301–305. This paper precisely addresses the impact of robotic training on outcomes. These issues are of concern for both the patients and residency programs. CrossRefPubMedGoogle Scholar
  22. 22.
    Schroeck FR, de Sousa CA, Kalman RA, et al.: Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate. Urology 2008, 71:597–601.CrossRefPubMedGoogle Scholar
  23. 23.
    Menon M, Tewari A, Peabody J: Vattikuti Institute prostatectomy: technique. J Urol 2003, 169:2289–2292.CrossRefPubMedGoogle Scholar
  24. 24.
    Samadi D, Levinson A, Hakimi A, et al.: From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol 2007, 25:105–110.CrossRefPubMedGoogle Scholar
  25. 25.
    Mimic: dV-Trainer skills training for robotic surgery. Available at http://www.mimic.ws/products/MIMIC-dV-Trainer-Brochure.pdf. Accessed January 2010.
  26. 26.
    • Sweet RM, McDougall EM: Simulation and computer-animated devices: the new minimally invasive skills training paradigm. Urol Clin North Am 2008, 35:519–531. We strongly believe that there is a need for a dry lab that can mimic console experience. Such a training paradigm will have a direct impact on learning curve, operating time, and outcomes. CrossRefPubMedGoogle Scholar
  27. 27.
    Lendvay TS, Casale P, Sweet R, Peters C: Initial validation of a virtual-reality robotic simulator. J Robotic Surg 2008, 2:145–149.CrossRefGoogle Scholar
  28. 28.
    Katsavelis D, Siu KC, Brown-Clerk B, et al.: Validated robotic laparoscopic surgical training in a virtual-reality environment. Surg Endosc 2009, 23:66–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Brown-Clerk B, Siu KC, Katsavelis D, et al.: Validating advanced robot-assisted laparoscopic training task in virtual reality. Stud Health Technol Inform 2008, 132:45–49.PubMedGoogle Scholar
  30. 30.
    Meti: SurgicalSIM RSS. Available at http://www.meti.com/products_ss_rss.htm. Accessed January 2010.
  31. 31.
    Intuitive Surgical, Inc.: da Vinci Si HD Surgical System. Available at http://www.intuitivesurgical.com/products/davinci_surgicalsystem/da-vinci-si-surgical-system.aspx. Accessed January 2010.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sonal Grover
    • 1
  • Gerald Y. Tan
    • 1
  • Abhishek Srivastava
    • 1
  • Robert A. Leung
    • 1
  • Ashutosh K. Tewari
    • 1
  1. 1.James Buchanan Brady Foundation Department of UrologyWeill Medical College of Cornell UniversityNew YorkUSA

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