Alessandro Larcher1, Geert De Naeyer2, Filippo Turri3, Paolo Dell'Oglio4, Umberto Capitanio5, Justin W Collins6, Peter Wiklund7, Henk Van Der Poel8, Francesco Montorsi5, Alexandre Mottrie3. 1. Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. Electronic address: alelarcher@gmail.com. 2. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 3. ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 4. Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 5. Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 6. ORSI Academy, Melle, Belgium; Department of Urology, Karolinska University Hospital, Stockholm, Sweden. 7. Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY, USA. 8. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Abstract
BACKGROUND: No validated training program for robot-assisted partial nephrectomy (RAPN) exists. OBJECTIVE: To define the structure and provide a pilot clinical validation of a curriculum for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS: A modified Delphi consensus methodology involving 27 experts defined curriculum structure. One trainee completed the curriculum under the mentorship of an expert. A total of 40 patients treated with curriculum RAPN (cRAPN) were compared with 160 patients treated with standard of care (sRAPN). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: To define curriculum structure, consensus was defined as ≥90% expert agreement. To investigate curriculum safety, perioperative morbidity, renal function, and pathologic outcomes were evaluated. To investigate curriculum efficacy, RAPN steps and modules attempted and completed by the trainee were evaluated. Propensity score matching identified comparable cRAPN and sRAPN cases. Mann-Whitney U test, chi-square test, and linear regression were used to investigate the impact of the curriculum on patient's outcome and the impact of trainee's experience on surgical independence. RESULTS AND LIMITATIONS: Consensus-based key statements defined curriculum structure. No difference was recorded between cRAPN and sRAPN with respect to intraoperative or overall and grade-specific postoperative complications, blood loss, ischemia time, postoperative estimated glomerular filtration rate, and positive surgical margins (all p>0.05). Conversely, operative time was longer after cRAPN (p<0.0001). The trainee completed all phases of the curriculum and the trainee's experience was associated with more steps attempted/completed and increasing complexity of module attempted/completed (all p<0.0001). The limitations of the study are the enrolment of a single trainee at a single institution and the small sample size. Accordingly, the large confidence intervals observed cannot exclude inferior outcomes in case of cRAPN and further study is required to confirm safety. CONCLUSIONS: The European Association of Urology (EAU) Robotic Urology Section (ERUS) curriculum for RAPN can protect patients from suboptimal outcome during the learning curve of the surgeon and can aid surgeons willing to start an RAPN program. PATIENT SUMMARY: Patients should be aware that structured training programs can reduce the risk of suboptimal outcome due to the learning curve of the surgeon.
BACKGROUND: No validated training program for robot-assisted partial nephrectomy (RAPN) exists. OBJECTIVE: To define the structure and provide a pilot clinical validation of a curriculum for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS: A modified Delphi consensus methodology involving 27 experts defined curriculum structure. One trainee completed the curriculum under the mentorship of an expert. A total of 40 patients treated with curriculum RAPN (cRAPN) were compared with 160 patients treated with standard of care (sRAPN). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: To define curriculum structure, consensus was defined as ≥90% expert agreement. To investigate curriculum safety, perioperative morbidity, renal function, and pathologic outcomes were evaluated. To investigate curriculum efficacy, RAPN steps and modules attempted and completed by the trainee were evaluated. Propensity score matching identified comparable cRAPN and sRAPN cases. Mann-Whitney U test, chi-square test, and linear regression were used to investigate the impact of the curriculum on patient's outcome and the impact of trainee's experience on surgical independence. RESULTS AND LIMITATIONS: Consensus-based key statements defined curriculum structure. No difference was recorded between cRAPN and sRAPN with respect to intraoperative or overall and grade-specific postoperative complications, blood loss, ischemia time, postoperative estimated glomerular filtration rate, and positive surgical margins (all p>0.05). Conversely, operative time was longer after cRAPN (p<0.0001). The trainee completed all phases of the curriculum and the trainee's experience was associated with more steps attempted/completed and increasing complexity of module attempted/completed (all p<0.0001). The limitations of the study are the enrolment of a single trainee at a single institution and the small sample size. Accordingly, the large confidence intervals observed cannot exclude inferior outcomes in case of cRAPN and further study is required to confirm safety. CONCLUSIONS: The European Association of Urology (EAU) Robotic Urology Section (ERUS) curriculum for RAPN can protect patients from suboptimal outcome during the learning curve of the surgeon and can aid surgeons willing to start an RAPN program. PATIENT SUMMARY:Patients should be aware that structured training programs can reduce the risk of suboptimal outcome due to the learning curve of the surgeon.
Authors: Erika Palagonia; Elio Mazzone; Geert De Naeyer; Frederiek D'Hondt; Justin Collins; Pawel Wisz; Fijs W B Van Leeuwen; Henk Van Der Poel; Peter Schatteman; Alexandre Mottrie; Paolo Dell'Oglio Journal: World J Urol Date: 2019-08-19 Impact factor: 4.226
Authors: Iulia Andras; Elio Mazzone; Fijs W B van Leeuwen; Geert De Naeyer; Matthias N van Oosterom; Sergi Beato; Tessa Buckle; Shane O'Sullivan; Pim J van Leeuwen; Alexander Beulens; Nicolae Crisan; Frederiek D'Hondt; Peter Schatteman; Henk van Der Poel; Paolo Dell'Oglio; Alexandre Mottrie Journal: World J Urol Date: 2019-11-27 Impact factor: 4.226
Authors: Giuseppe Rosiello; Alessandro Larcher; Giuseppe Fallara; Giuseppe Basile; Daniele Cignoli; Gianmarco Colandrea; Chiara Re; Francesco Trevisani; Pierre I Karakiewicz; Andrea Salonia; Roberto Bertini; Alberto Briganti; Francesco Montorsi; Umberto Capitanio Journal: World J Urol Date: 2020-10-29 Impact factor: 4.226
Authors: Paolo Dell'Oglio; Filippo Turri; Alessandro Larcher; Frederiek D'Hondt; Rafael Sanchez-Salas; Bernard Bochner; Joan Palou; Robin Weston; Abolfazl Hosseini; Abdullah E Canda; Jørgen Bjerggaard; Giovanni Cacciamani; Kasper Ørding Olsen; Inderbir Gill; Thierry Piechaud; Walter Artibani; Pim J van Leeuwen; Arnulf Stenzl; John Kelly; Prokar Dasgupta; Carl Wijburg; Justin W Collins; Mihir Desai; Henk G van der Poel; Francesco Montorsi; Peter Wiklund; Alexandre Mottrie Journal: Eur Urol Focus Date: 2021-01-02
Authors: Philip Zeuschner; Irmengard Meyer; Stefan Siemer; Michael Stoeckle; Gudrun Wagenpfeil; Stefan Wagenpfeil; Matthias Saar; Martin Janssen Journal: Ann Surg Oncol Date: 2020-07-24 Impact factor: 5.344
Authors: Alexander J W Beulens; Paulo Dell'Oglio; Hannah Kiss; Willem M Brinkman; Alessandro Larcher; Alexandre Mottrie; Christian Wagner; Henk G van der Poel Journal: Eur Urol Open Sci Date: 2020-05-04