Training surgeons to use robotic technology involves learning curves, and a study has found that robotic technologies have unique learning curve profiles that have implications for the time and number of procedures needed to achieve competence.

Giorgio Mazzon, MD, of the Institute of Urology at University College Hospital, London, and his colleagues reviewed the literature on training surgeons in the use of a variety of technologies for urological procedures. They analyzed learning curves for virtual reality robotic simulators, robot-assisted laparoscopic radical prostatectomy (RALP), robot-assisted radical cystectomy (RARC), and robot-assisted partial nephrectomy (RAPN) ( Curr Urol Rep. 2017 Sep 23;18:89 ).

For virtual reality training programs, recommendations for achieving safety and competence is between 4 and 12 hours of training in a simulator. One study showed that surgeons were required to complete 11 basic robotic surgical tasks and 6 advanced tasks. The basic and advanced tasks were completed 89.9% and 75% of the time and within 7 hours and in just over 6 hours, respectively ( J Endourol. 2015;29[11]:1289-93 ).Studies of RALP show that prior experience in open radical prostatectomy improved the learning curve for surgeon RALP performance. One study posited that it only took 50-120 cases for the learning curve to plateau in these surgeons ( J Endourol. 2011 Oct 25[10]:1633-7 ).

RARC learning curves are more rapid than RALP, but this may be due to the fact that most surgeons practice RALP before learning RARC. It is estimated that it takes 21 procedures for operating time to plateau and 30 patients for proper lymph node yield and positive surgical margins of less than 5% to occur ( Eur Urol. 2010 Aug;58[2]:197-202 ).Safety and competence in RAPN is usually defined by operating times, warm ischemic time, positive surgical margin, and complication rates. It has been reported that RAPN can be safely performed with completion of 25-30 cases ( Eur Urol. 2010 Jul;58[1]:127-32 ).The results of the review “should inform trainers and trainees on what outcomes are expected at a given stage of training,” according to the investigators.

They reported no relevant financial disclosures.


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