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Basile G, Gallioli A, Diana P, Gallagher A, Larcher A, Graefen M, Harke N, Traxer O, Tilki D, Van Der Poel H, Emiliani E, Angerri O, Wagner C, Montorsi F, Wiklund P, Somani B, Buffi N, Mottrie A, Liatsikos E, Breda A. Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review. Eur Urol 2024:S0302-2838(24)02304-2. [PMID: 38644144 DOI: 10.1016/j.eururo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways. METHODS We systematically reviewed the literature using PubMed/Medline, Embase, and Web of Science databases. The validity of each training model was assessed. The methodological quality of studies on metrics and curricula was graded using the MERSQI scale. The level of evidence (LoE) and level of recommendation for surgical curricula were awarded using the educational Oxford Centre for Evidence-Based Medicine classification. KEY FINDINGS AND LIMITATIONS A total of 75 studies were identified. Many simulators have been developed to aid trainees in mastering skills required for both robotic and endourology procedures, but only four demonstrated predictive validity. For assessment of trainee proficiency, we identified 18 in robotics training and six in endourology training; however, the majority are Likert-type scales. Although proficiency-based progression (PBP) curricula demonstrated superior outcomes to traditional training in preclinical settings, only four of six (67%) in robotics and three of nine (33%) in endourology are PBP-based. Among these, the Fundamentals of Robotic Surgery and the SIMULATE curricula have the highest LoE (level 1b). The lack of a quantitative synthesis is the main limitation of our study. CONCLUSIONS AND CLINICAL IMPLICATIONS Training curricula that integrate simulators and PBP methodology have been introduced to standardize trainee outcomes in robotics and endourology. However, evidence regarding their educational impact remains restricted to preclinical studies. Efforts should be made to expand these training programs to different surgical procedures and assess their clinical impact. PATIENT SUMMARY Simulation-based training and programs in which progression is based on proficiency represent the new standard of quality for achieving surgical proficiency in urology. Studies have demonstrated the educational impact of these approaches. However, there are still no standardized training pathways for several urology procedures.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Anthony Gallagher
- Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Coleraine, UK; ORSI Academy, Melle, Belgium
| | | | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Olivier Traxer
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | | | - Peter Wiklund
- Icahn School of Medicine, Mount Sinai Health System New York City, NY, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Nicolò Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, OLV Hospital, Aalst, Belgium
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
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Olsen RG, Konge L, Hayatzaki K, Mortensen MA, Bube SH, Røder A, Azawi N, Bjerrum F. Laypersons versus experienced surgeons in assessing simulated robot-assisted radical prostatectomy. World J Urol 2023; 41:3745-3751. [PMID: 37882808 PMCID: PMC10693505 DOI: 10.1007/s00345-023-04664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Feedback is important for surgical trainees but it can be biased and time-consuming. We examined crowd-sourced assessment as an alternative to experienced surgeons' assessment of robot-assisted radical prostatectomy (RARP). METHODS We used video recordings (n = 45) of three RARP modules on the RobotiX, Simbionix simulator from a previous study in a blinded comparative assessment study. A group of crowd workers (CWs) and two experienced RARP surgeons (ESs) evaluated all videos with the modified Global Evaluative Assessment of Robotic Surgery (mGEARS). RESULTS One hundred forty-nine CWs performed 1490 video ratings. Internal consistency reliability was high (0.94). Inter-rater reliability and test-retest reliability were low for CWs (0.29 and 0.39) and moderate for ESs (0.61 and 0.68). In an Analysis of Variance (ANOVA) test, CWs could not discriminate between the skill level of the surgeons (p = 0.03-0.89), whereas ES could (p = 0.034). CONCLUSION We found very low agreement between the assessments of CWs and ESs when they assessed robot-assisted radical prostatectomies. As opposed to ESs, CWs could not discriminate between surgical experience using the mGEARS ratings or when asked if they wanted the surgeons to perform their robotic surgery.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), University Hospital - Rigshospitalet, Ryesgade 53B, 2100, Copenhagen, Denmark.
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University Hospital - Rigshospitalet, Ryesgade 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Mike Allan Mortensen
- Department of Urology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sarah Hjartbro Bube
- Copenhagen Academy for Medical Education and Simulation (CAMES), University Hospital - Rigshospitalet, Ryesgade 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nessn Azawi
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), University Hospital - Rigshospitalet, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Surgery, Herlev-Gentofte Hospital, Herlev, Denmark
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Bube SH, Brix R, Christensen MB, Thostrup M, Grimstrup S, Hansen RB, Dahl C, Konge L, Azawi N. Surgical experience is predictive for bladder tumour resection quality. Scand J Urol 2022; 56:391-396. [PMID: 36065477 DOI: 10.1080/21681805.2022.2119271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle. METHODS A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT. RESULTS Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT. CONCLUSIONS It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.
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Affiliation(s)
- Sarah H Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Brix
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | | | - Mathias Thostrup
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Rikke B Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Claus Dahl
- Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,University of Copenhagen, Copenhagen, Denmark
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Bube SH, Kingo PS, Madsen MG, Vásquez JL, Norus T, Olsen RG, Dahl C, Hansen RB, Konge L, Azawi N. National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients. EUR UROL SUPPL 2022; 39:29-35. [PMID: 35528788 PMCID: PMC9068726 DOI: 10.1016/j.euros.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analyses Results and limitations Conclusions Patient summary
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