Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium.
Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
BJU Int. 2023 Jul;132(1):84-91. doi: 10.1111/bju.15993. Epub 2023 Mar 26.
To provide the first clinical validation of the European Association of Urology Robotic Urology Section (ERUS) curriculum for training in robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).
The ERUS proposed a structured curriculum, divided into 11 steps, to train novice surgeons and help overcome the steep learning curve associated with iRARC. In this study, one trainee completed the curriculum under the mentorship of an expert. Twenty-one patients were operated on by the trainee following the proposed iRARC curriculum [(t)iRARC group] and were compared with 42 patients treated with the standard of care by the mentor [(m)iRARC group]. To evaluate curriculum safety, peri-operative outcomes, surgical margins and complications were assessed. Propensity-score matching (1:2) was used to identify comparable (t)iRARC and (m)iRARC cases. Matched variables included age, body mass index, neoadjuvant therapy, American Society of Anesthesiologists score and cT stage. Mann-Whitney and chi-squared tests were used to compare peri- and postoperative outcomes between the two cohorts. To evaluate curriculum efficacy, steps attempted and completed by the trainee were assessed and studied as a function of growing surgical experience of the trainee.
The trainee progressed in proficiency-based training through steps of increasing difficulty. No differences in estimated blood loss, positive soft tissue margins, number of resected lymph nodes, overall and high-grade complications, or 90-day readmissions between the (t)iRARC and (m)iRARC groups were observed (all P > 0.05). However, operating time was significantly longer in the (t)iRARC group (P = 0.01). Of the 209 available steps, the trainee attempted 168 (80%) and successfully performed 125 (60%). Increasing experience was associated with more steps being successfully performed (P < 0.001).
The proposed ERUS curriculum assists naïve surgeons during the learning curve for iRARC and should be encouraged in order to guarantee optimal outcomes during the learning phase of this procedure.
为欧洲泌尿外科学会机器人泌尿外科分会（ERUS）机器人辅助根治性膀胱切除术联合体内尿流改道术（iRARC）培训课程提供首次临床验证。
ERUS 提出了一个结构化课程，分为 11 个步骤，旨在培训新手外科医生，并帮助克服与 iRARC 相关的陡峭学习曲线。在这项研究中，一名学员在专家的指导下完成了课程。21 名学员按照提出的 iRARC 课程进行手术[(t)iRARC 组]，并与 42 名由导师按标准治疗的患者[(m)iRARC 组]进行比较。为了评估课程的安全性，评估了围手术期结局、手术切缘和并发症。采用倾向评分匹配（1:2）比较了可比较的(t)iRARC 和(m)iRARC 病例。匹配变量包括年龄、体重指数、新辅助治疗、美国麻醉医师协会评分和 cT 分期。使用 Mann-Whitney 和卡方检验比较了两组的围手术期结局。为了评估课程的疗效，评估了学员尝试和完成的步骤，并作为学员手术经验增长的函数进行研究。
学员在以技能为基础的培训中逐步提高熟练程度。(t)iRARC 和(m)iRARC 组之间在估计失血量、软组织切缘阳性、切除的淋巴结数量、总并发症和高级别并发症或 90 天再入院率方面无差异（均 P>0.05）。然而，(t)iRARC 组的手术时间明显较长（P=0.01）。在 209 个可用步骤中，学员尝试了 168 个（80%），成功完成了 125 个（60%）。经验的增加与更多步骤的成功完成相关（P<0.001）。
提出的 ERUS 课程在 iRARC 的学习曲线期间为新手外科医生提供帮助，应鼓励该课程以保证在该手术学习阶段获得最佳结果。
