336 Chapter 13 Reflection and future recommendations The challenge for novice surgeons is how to learn new surgical procedures in the best possible way, and for expert surgeons how to continuously improve individual performance by analysing past performances and subsequently use this as a lesson for the future. What are the best methods to educate surgeons in robotic surgery? No general training guidelines and certification criteria for Robot assisted surgery (RAS) have been set by European, American or National associations for urology. In contrast to laparoscopic surgery where the European Basic Laparoscopic Urological Skills (E-BLUS) examination1–3 have been accepted, no such initiatives are currently in place for RAS. We showed there is a large difference in the criteria for novices starting RAS between training hospitals in the Netherlands. This shows, in order to guarantee a basic level of RAS skills, there is a need for the implementation of general guidelines and certification criteria. Although not all residents will perform RAS in their future careers a basic level of RAS skills should be acquired to ensure the residents get acquainted with the possibilities of RAS and are able to counsel patients on RAS surgeries. The certification of residents1–3 needs to be a mandatory step in the residency curriculum, like the E-BLUS examination, to ensure patient safety and reduce the risks for patients.7 To implement training guidelines and certification criteria for starting RAS multiple conditions should be met: validated training curricula should be available, certification criteria need to be set, and the acceptance and feasibility in the clinical practice should be investigated. When implementing an advanced RAS training program for residents the question remains whether all residents should learn how to perform RAS and if not whom we should train. According to literature, the training of RAS can be stratified by content of training (i.e., system training and procedural training)27–29 or by phase of the training (i.e., the preclinical phase, the bedside assistant/table side assistant phase, the operative console phase).27,30 These different methods of training stratification can be used as a template for the design of a multi-step modular structured training program for RAS. The implementation of a multi-step modular training program could be a first start in the creation of general training guidelines and certification criteria. This multi-step training program should start with a basic RAS skills training consisting of hands-on training combined with theoretical information on the aspects of the robot system (i.e., the preclinical phase or system training), and basic surgical skills for RAS (ii.e., draping and
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