Robot-assisted laparoscopic radical prostatectomy using modular training programme in a private hospital
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ORIGINAL ARTICLE
Robot-assisted laparoscopic radical prostatectomy using modular training programme in a private hospital Handoo Rhee • Jason Paterdis • Peter Heathcote
Received: 4 January 2013 / Accepted: 23 January 2013 Ó Springer-Verlag London 2013
Abstract The aim of the study was to demonstrate an efficacious robotic fellowship model that balances safety of patients, time efficiency and adequate training, in a private hospital. Sixty-four patients underwent robot-assisted laparoscopic radical prostatectomy using a 13-step modular training programme in a single private institute. The patients were compared with 64 consecutive patients operated on by the mentoring surgeon immediately prior to the implementation of the programme. The main parameters analysed included console time, total operating time, blood loss, positive surgical margin rate and postoperative complications. There was a marginal difference in mean console time (92.67 vs. 90.41 min; p = 0.02). Statistical difference disappeared when comparing mean total operating time (136.09 vs. 134.14 min; p = 0.16), mean blood loss (165 vs. 172 ml; p = 0.96) and margin positivity (8 vs. 13; p = 0.34). The trainee was able to complete significant numbers of modular training steps whilst maintaining momentum of the operation from the commencement of the fellowship programme. This study demonstrates that a comprehensive modular training programme in complicated robotic procedures could be implemented without compromising patient safety or time efficiency. Keywords Robot Training Fellowship Prostatectomy Modular Surgery Introduction Since laparoscopic radical prostatectomy was first introduced in 1992, it has evolved rapidly to incorporate robots and associated technologies. Robot-assisted laparoscopic H. Rhee (&) J. Paterdis P. Heathcote Greenslopes Private Hospital, Greenslopes, Australia e-mail: [email protected]
radical prostatectomy (RALRP) is now a well-accepted option for patients with localized prostate cancer. Its use and popularity is justified by extensive evidence that demonstrates comparable short-term oncological and functional outcomes. As the technology now evolves into its second phase with competitive robots, it is a technology that cannot be ignored [1–7]. The next great challenge in incorporating robots in surgery is passing the knowledge from one generation of robotics surgeons to the next. To date, a significant amount of work has been dedicated to designing, developing and credentialing curricula and programmes around the world to enable surgeons and trainees to embrace the technology [8–18]. For example, some of the currently available training programmes include animal or cadaver laboratories, inanimate bench models, computer and virtual simulators and mentoring systems or fellowships. The American Urologists Association (AUA) now has a Robotic and Advanced Laparoscopic Urologic Oncology course as well as an AUA Surgical Robot Basic Skills Training Centre, which would be invaluable to many trainees. Although they all h
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