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Modular Training for Robot-Assisted Radical Prostatectomy: Where to Begin?

Research output: Contribution to journalArticlepeer-review

Catherine Lovegrove, Kamran Ahmed, Giacomo Novara, Khurshid Guru, Alex Mottrie, Ben Challacombe, Henk Van der Poel, James Peabody, Prokar Dasgupta

Original languageEnglish
Pages (from-to)486-494
Number of pages9
JournalJournal Of Surgical Education
Issue number3
Early online date5 Dec 2016
Accepted/In press5 Dec 2016
E-pub ahead of print5 Dec 2016


King's Authors


OBJECTIVE: Effective training is paramount for patient safety. Modular training entails advancing through surgical steps of increasing difficulty. This study aimed to construct a modular training pathway for use in robot-assisted radical prostatectomy (RARP). It aims to identify the sequence of procedural steps that are learnt before surgeons are able to perform a full procedure without an intervention from mentor.

DESIGN: This is a multi-institutional, prospective, observational, longitudinal study. We used a validated training tool (RARP Score). Data regarding surgeons' stage of training and progress were collected for analysis. A modular training pathway was constructed with consensus on the level of difficulty and evaluation of individual steps. We identified and recorded the sequence of steps performed by fellows during their learning curves.

SETTING AND PARTICIPANTS: We included 15 urology fellows from UK, Europe, and Australia.

RESULTS: A total of 15 surgeons were assessed by mentors in 425 RARP cases over 8 months (range: 7-79) across 15 international centers. There were substantial differences in the sequence of RARP steps according to the chronology of the procedure, difficulty level, and the order in which surgeons actually learned steps. Steps were not attempted in chronological order. The greater the difficulty, the later the cohort first undertook the step (p = 0.021). The cohort undertook steps of difficulty level I at median case number 1. Steps of difficulty levels II, III, and IV showed more variation in median case number of the first attempt. We recommend that, in the operating theater, steps be learned in order of increasing difficulty. A new modular training route has been designed. This incorporates the steps of RARP with the following order of priority: difficulty level > median case number of first attempt > most frequently undertaken in surgical training.

CONCLUSIONS: An evidence-based modular training pathway has been developed that facilitates a safe introduction to RARP for novice surgeons.

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