Preston Mark A, Blew Brian D M, Breau Rodney H, Beiko Darren, Oake Stuart J, Watterson J D
Division of Urology, University of Ottawa, Ottawa, ON;
Can Urol Assoc J. 2010 Feb;4(1):42-6. doi: 10.5489/cuaj.09036.
We determined the status of Canadian training during senior residency in laparoscopic, robotic and endourologic surgery.
Fifty-six residents in their final year of urology residency training were surveyed in person in 2007 or 2008.
All residents completed the survey. Most residents (85.7%) train at centres performing more than 50 laparoscopic procedures yearly and almost all (96.4%) believe laparoscopic radical nephrectomy is the gold standard. About 82% of residents participated in a laparoscopic partial nephrectomy in 2008, compared to 64.7% in 2007. Of the respondents, 66% have participated in a laparoscopic prostatectomy and 54% believe the procedure has promising potential. Exposure and training in robotic-assisted laparoscopic procedures seem to be increasing as 35.7% of 2008 residents have access to a surgical robot and 7% consider themselves trained in robotic-assisted procedures. Most residents (71.4%) train at centres that perform percutaneous ablation. However, 65% state the procedure is performed solely by radiologists. Percutaneous nephrolithotomy is widely performed (98.2%), but only 37.5% of residents report training in obtaining primary percutaneous renal access. Despite only 12.5% of residents ranking their laparoscopic experience as below average or poor, an increasing proportion of graduating residents are pursuing fellowships in minimally-invasive urology.
Laparoscopic nephrectomy is commonly performed and is considered the standard of care by Canadian urology residents. Robotic-assisted surgery is becoming more common but will require continued evaluation by educators who will ultimately define its role in the urological residency training curriculum. Minimally-invasive surgical fellowships remain popular, as Canadian residents do not feel adequately trained in certain advanced procedures. Urologists must strive to learn and adapt to new technologies or risk losing them to other specialties.
我们确定了加拿大泌尿外科住院医师高级培训阶段在腹腔镜、机器人及腔内泌尿外科手术方面的培训状况。
2007年或2008年对56名处于泌尿外科住院医师培训最后一年的学员进行了现场调查。
所有学员均完成了调查。大多数学员（85.7%）在每年开展超过50例腹腔镜手术的中心接受培训，几乎所有学员（96.4%）认为腹腔镜根治性肾切除术是金标准。2008年约82%的学员参与了腹腔镜肾部分切除术，2007年这一比例为64.7%。在受访者中，66%参与过腹腔镜前列腺切除术，54%认为该手术有很大潜力。随着2008年35.7%的学员能够使用手术机器人且7%认为自己接受过机器人辅助手术培训，机器人辅助腹腔镜手术的接触和培训似乎在增加。大多数学员（71.4%）在开展经皮消融术的中心接受培训。然而，65%表示该手术仅由放射科医生进行。经皮肾镜取石术广泛开展（98.2%），但只有37.5%的学员报告接受过获得初次经皮肾穿刺通道的培训。尽管只有12.5%的学员将自己的腹腔镜经验评为低于平均水平或较差，但越来越多即将毕业的学员正在寻求微创泌尿外科方面的 fellowship 培训。
腹腔镜肾切除术普遍开展，被加拿大泌尿外科住院医师视为治疗标准。机器人辅助手术正变得越来越普遍，但需要教育工作者持续评估，他们最终将确定其在泌尿外科住院医师培训课程中的作用。微创外科 fellowship 培训仍然很受欢迎，因为加拿大住院医师觉得自己在某些先进手术方面未得到充分培训。泌尿外科医生必须努力学习并适应新技术，否则可能会被其他专科超越。
