59 Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance Introduction The advent of robotic surgery has dramatically changed the landscape of minimally invasive surgery. The number of robotic procedures performed per year is rapidly increasing all over the world with more and more centres equipping with the robotic technology.1 For the Da Vinci surgical systems, a basic robotic surgery training with “the introduction to the robotic system” is usually provided by the manufacturer to surgeons starting with robot-assisted surgery (RAS). However, not all the novice robotic surgeons have the access to this basic training programme which could result in a serious gap of knowledge. Moreover, the basic training in robotic surgery is not included standard in most of the resident and fellowship curricula. 2,3 In 2010, the Dutch Health Care Inspectorate (IGJ) published a report stating ‘insufficient carefulness at the introduction of surgical robots. In this report, the IGJ expressed its concern regarding RAS.2,4 The report stated that in most hospitals, the criteria for the training of novice robot-assisted surgeons were either vague or even completely lacking.2,3 To clarify criteria for starting robot-assisted surgery, the Netherlands Institute for Health Services Research (NIVEL) developed, in cooperation with urologists, gynaecologists and surgeons, the ‘Basic Proficiency Requirements for the safe use of robotic surgery’ (BPR).5 This provides a guide to ensure that all surgeons who are using a surgical robot have a minimum required skills for RAS. Most of the Dutch urologists agreed that the basics of RAS should be learned in the context of well-defined structured training programmes, in order to guarantee quality and safety to patients and OR-personnel .6 Therefore, it is crucial that novice surgeons are appropriately trained before operating on patients.7,8 Simulation-based education (SBE) has been proven to be an effective method for surgical training. SBE is a teaching method where simulation mimics aspects of clinical care and various real-live scenarios are used for learning purposes. This allows to save the costs of operating rooms occupancy and avoid the risks related to training on patients to avoid patients being exposed to a training situation).9–12 Simulators have become more sophisticated providing high-fidelity simulation and (video) real-time feedback. The most advanced surgical simulators allow training of advanced surgical skill allowing the performance of complete procedures with a stepwise learning method.13 Proctoring is a form of training where an experienced trainer supervises the trainee during the procedure and provides real-time feedback, in order to guide and assist the trainee during the acquisition of new skills. Proctoring is widely used in the oper-
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