Wagner Christian, Srougi Victor, Sanchez-Salas Rafael
aDepartment of Urology, St. Antonius-Hospital, Gronau, Germany bDepartment of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France cDivision of Urology, University of Sao Paulo, Sao Paulo, Brazil.
Curr Opin Urol. 2017 Jul;27(4):323-329. doi: 10.1097/MOU.0000000000000409.
Robot-assisted radical prostatectomy (RARP) has been embraced by urologists and has become a treatment standard in many countries already. Learning how to perform a RARP is challenging and has not yet been standardized. The current review summarizes the latest concepts regarding the most effective way of training for RARP.
The strategy to learn RARP should comprise didactic activities, skills lab training, participating in surgeries and mentorship. Skills lab and virtual simulators are valuable tools to develop manual abilities and to overcome the initial technical learning curve. Participating in surgeries is crucial for familiarization with the robot installation, steps of the surgical procedure and is essential for troubleshooting. Mentorship improves learning and is the safest way to initiate real practice. Innate and individual background variances were suggested to influence the learning process; however, there is paucity of robust evidence correlating previous surgical experience and, for example videogame playing with faster learning of RARP. Structured curricula were proposed to orient the training for robotic surgery; currently, only one is focused exclusively on urology.
Systematic training is the most effective way to learn and surpass the possibly intense learning curve of RARP. Training activities should focus on developing cognitive and manual abilities. The existing curricula for robotic surgery training still require constant refinement; however, they offer good and structured guidance to train for RARP.
机器人辅助根治性前列腺切除术（RARP）已被泌尿外科医生所接受，并且在许多国家已成为一种治疗标准。学习如何进行RARP具有挑战性，且尚未标准化。本综述总结了关于RARP最有效训练方式的最新概念。
学习RARP的策略应包括理论教学活动、技能实验室培训、参与手术和导师指导。技能实验室和虚拟模拟器是培养手动能力以及克服初始技术学习曲线的宝贵工具。参与手术对于熟悉机器人安装、手术步骤至关重要，并且对于故障排除也必不可少。导师指导可促进学习，是开始实际操作的最安全方式。有人提出先天和个体背景差异会影响学习过程；然而，缺乏有力证据表明先前的手术经验以及例如玩电子游戏与更快学习RARP之间存在关联。有人提出结构化课程来指导机器人手术培训；目前，仅有一门课程专门针对泌尿外科。
系统培训是学习并超越RARP可能存在的高强度学习曲线的最有效方式。培训活动应侧重于培养认知和手动能力。现有的机器人手术培训课程仍需不断完善；然而，它们为RARP培训提供了良好且结构化的指导。
