Serveur d'exploration sur les dispositifs haptiques

Attention, ce site est en cours de développement !
Attention, site généré par des moyens informatiques à partir de corpus bruts.
Les informations ne sont donc pas validées.

Robotic surgical skill acquisition: What one needs to know?

Identifieur interne : 003625 ( Ncbi/Merge ); précédent : 003624; suivant : 003626

Robotic surgical skill acquisition: What one needs to know?

Auteurs : Akshay Sood [États-Unis] ; Wooju Jeong [États-Unis] ; Rajesh Ahlawat [Inde] ; Logan Campbell [États-Unis] ; Shruti Aggarwal [États-Unis] ; Mani Menon [États-Unis] ; Mahendra Bhandari [États-Unis]

Source :

RBID : PMC:4290108

Abstract

Robotic surgery has been eagerly adopted by patients and surgeons alike in the field of urology, over the last decade. However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Accordingly, in this review, we aim to highlight ‘who’ needs to learn ‘what’ and ‘how’, to become competent in robotic surgery. We demonstrate that both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. With regard to training curricula, a variety of training programs such as academic fellowships, mini-fellowships, and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons adequately. Fellowships provide the most comprehensive training, however, may not be suitable to all surgeon-learners secondary to the long-term time commitment. For these surgeon-learners short-term courses such as the mini-fellowships or mentored skill courses might be more apt. Lastly, with regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.


Url:
DOI: 10.4103/0972-9941.147662
PubMed: 25598593
PubMed Central: 4290108

Links toward previous steps (curation, corpus...)


Links to Exploration step

PMC:4290108

Le document en format XML

<record>
<TEI>
<teiHeader>
<fileDesc>
<titleStmt>
<title xml:lang="en">Robotic surgical skill acquisition: What one needs to know?</title>
<author>
<name sortKey="Sood, Akshay" sort="Sood, Akshay" uniqKey="Sood A" first="Akshay" last="Sood">Akshay Sood</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Jeong, Wooju" sort="Jeong, Wooju" uniqKey="Jeong W" first="Wooju" last="Jeong">Wooju Jeong</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Ahlawat, Rajesh" sort="Ahlawat, Rajesh" uniqKey="Ahlawat R" first="Rajesh" last="Ahlawat">Rajesh Ahlawat</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">Kidney and Urology Institute, Medanta — The Medicity, Gurgaon, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Kidney and Urology Institute, Medanta — The Medicity, Gurgaon</wicri:regionArea>
<wicri:noRegion>Gurgaon</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Campbell, Logan" sort="Campbell, Logan" uniqKey="Campbell L" first="Logan" last="Campbell">Logan Campbell</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Aggarwal, Shruti" sort="Aggarwal, Shruti" uniqKey="Aggarwal S" first="Shruti" last="Aggarwal">Shruti Aggarwal</name>
<affiliation wicri:level="2">
<nlm:aff id="aff3">Department of Medicine, Metrowest Medical Center, Framingham, MA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Medicine, Metrowest Medical Center, Framingham, MA</wicri:regionArea>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Menon, Mani" sort="Menon, Mani" uniqKey="Menon M" first="Mani" last="Menon">Mani Menon</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Bhandari, Mahendra" sort="Bhandari, Mahendra" uniqKey="Bhandari M" first="Mahendra" last="Bhandari">Mahendra Bhandari</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
</titleStmt>
<publicationStmt>
<idno type="wicri:source">PMC</idno>
<idno type="pmid">25598593</idno>
<idno type="pmc">4290108</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290108</idno>
<idno type="RBID">PMC:4290108</idno>
<idno type="doi">10.4103/0972-9941.147662</idno>
<date when="2015">2015</date>
<idno type="wicri:Area/Pmc/Corpus">002768</idno>
<idno type="wicri:Area/Pmc/Curation">002768</idno>
<idno type="wicri:Area/Pmc/Checkpoint">000363</idno>
<idno type="wicri:Area/Ncbi/Merge">003625</idno>
</publicationStmt>
<sourceDesc>
<biblStruct>
<analytic>
<title xml:lang="en" level="a" type="main">Robotic surgical skill acquisition: What one needs to know?</title>
<author>
<name sortKey="Sood, Akshay" sort="Sood, Akshay" uniqKey="Sood A" first="Akshay" last="Sood">Akshay Sood</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Jeong, Wooju" sort="Jeong, Wooju" uniqKey="Jeong W" first="Wooju" last="Jeong">Wooju Jeong</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Ahlawat, Rajesh" sort="Ahlawat, Rajesh" uniqKey="Ahlawat R" first="Rajesh" last="Ahlawat">Rajesh Ahlawat</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">Kidney and Urology Institute, Medanta — The Medicity, Gurgaon, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Kidney and Urology Institute, Medanta — The Medicity, Gurgaon</wicri:regionArea>
<wicri:noRegion>Gurgaon</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Campbell, Logan" sort="Campbell, Logan" uniqKey="Campbell L" first="Logan" last="Campbell">Logan Campbell</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Aggarwal, Shruti" sort="Aggarwal, Shruti" uniqKey="Aggarwal S" first="Shruti" last="Aggarwal">Shruti Aggarwal</name>
<affiliation wicri:level="2">
<nlm:aff id="aff3">Department of Medicine, Metrowest Medical Center, Framingham, MA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Medicine, Metrowest Medical Center, Framingham, MA</wicri:regionArea>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Menon, Mani" sort="Menon, Mani" uniqKey="Menon M" first="Mani" last="Menon">Mani Menon</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Bhandari, Mahendra" sort="Bhandari, Mahendra" uniqKey="Bhandari M" first="Mahendra" last="Bhandari">Mahendra Bhandari</name>
<affiliation wicri:level="2">
<nlm:aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI</wicri:regionArea>
<placeName>
<region type="state">Michigan</region>
</placeName>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Journal of Minimal Access Surgery</title>
<idno type="ISSN">0972-9941</idno>
<idno type="eISSN">1998-3921</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>Robotic surgery has been eagerly adopted by patients and surgeons alike in the field of urology, over the last decade. However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Accordingly, in this review, we aim to highlight ‘who’ needs to learn ‘what’ and ‘how’, to become competent in robotic surgery. We demonstrate that both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. With regard to training curricula, a variety of training programs such as academic fellowships, mini-fellowships, and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons adequately. Fellowships provide the most comprehensive training, however, may not be suitable to all surgeon-learners secondary to the long-term time commitment. For these surgeon-learners short-term courses such as the mini-fellowships or mentored skill courses might be more apt. Lastly, with regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.</p>
</div>
</front>
<back>
<div1 type="bibliography">
<listBibl>
<biblStruct>
<analytic>
<author>
<name sortKey="Polychronidis, A" uniqKey="Polychronidis A">A Polychronidis</name>
</author>
<author>
<name sortKey="Laftsidis, P" uniqKey="Laftsidis P">P Laftsidis</name>
</author>
<author>
<name sortKey="Bounovas, A" uniqKey="Bounovas A">A Bounovas</name>
</author>
<author>
<name sortKey="Simopoulos, C" uniqKey="Simopoulos C">C Simopoulos</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Jeong, W" uniqKey="Jeong W">W Jeong</name>
</author>
<author>
<name sortKey="Peabody, Jo" uniqKey="Peabody J">JO Peabody</name>
</author>
<author>
<name sortKey="Hemal, Ak" uniqKey="Hemal A">AK Hemal</name>
</author>
<author>
<name sortKey="Menon, M" uniqKey="Menon M">M Menon</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lanfranco, Ar" uniqKey="Lanfranco A">AR Lanfranco</name>
</author>
<author>
<name sortKey="Castellanos, Ae" uniqKey="Castellanos A">AE Castellanos</name>
</author>
<author>
<name sortKey="Desai, Jp" uniqKey="Desai J">JP Desai</name>
</author>
<author>
<name sortKey="Meyers, Wc" uniqKey="Meyers W">WC Meyers</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Hayn, Mh" uniqKey="Hayn M">MH Hayn</name>
</author>
<author>
<name sortKey="Hussain, A" uniqKey="Hussain A">A Hussain</name>
</author>
<author>
<name sortKey="Mansour, Am" uniqKey="Mansour A">AM Mansour</name>
</author>
<author>
<name sortKey="Andrews, Pe" uniqKey="Andrews P">PE Andrews</name>
</author>
<author>
<name sortKey="Carpentier, P" uniqKey="Carpentier P">P Carpentier</name>
</author>
<author>
<name sortKey="Castle, E" uniqKey="Castle E">E Castle</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sukumar, S" uniqKey="Sukumar S">S Sukumar</name>
</author>
<author>
<name sortKey="Rogers, Cg" uniqKey="Rogers C">CG Rogers</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Abaza, R" uniqKey="Abaza R">R Abaza</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Ghani, Kr" uniqKey="Ghani K">KR Ghani</name>
</author>
<author>
<name sortKey="Rogers, Cg" uniqKey="Rogers C">CG Rogers</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Kumar, R" uniqKey="Kumar R">R Kumar</name>
</author>
<author>
<name sortKey="Ehlert, M" uniqKey="Ehlert M">M Ehlert</name>
</author>
<author>
<name sortKey="Jeong, W" uniqKey="Jeong W">W Jeong</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mufarrij, Pw" uniqKey="Mufarrij P">PW Mufarrij</name>
</author>
<author>
<name sortKey="Shah, Od" uniqKey="Shah O">OD Shah</name>
</author>
<author>
<name sortKey="Berger, Ad" uniqKey="Berger A">AD Berger</name>
</author>
<author>
<name sortKey="Stifelman, Md" uniqKey="Stifelman M">MD Stifelman</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sammon, Jd" uniqKey="Sammon J">JD Sammon</name>
</author>
<author>
<name sortKey="Zhu, G" uniqKey="Zhu G">G Zhu</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Sukumar, S" uniqKey="Sukumar S">S Sukumar</name>
</author>
<author>
<name sortKey="Kim, Sp" uniqKey="Kim S">SP Kim</name>
</author>
<author>
<name sortKey="Sun, M" uniqKey="Sun M">M Sun</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sukumar, S" uniqKey="Sukumar S">S Sukumar</name>
</author>
<author>
<name sortKey="Roghmann, F" uniqKey="Roghmann F">F Roghmann</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Abdo, A" uniqKey="Abdo A">A Abdo</name>
</author>
<author>
<name sortKey="Menon, M" uniqKey="Menon M">M Menon</name>
</author>
<author>
<name sortKey="Sammon, Jd" uniqKey="Sammon J">JD Sammon</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Peters, Ca" uniqKey="Peters C">CA Peters</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Li, H" uniqKey="Li H">H Li</name>
</author>
<author>
<name sortKey="Sammon, J" uniqKey="Sammon J">J Sammon</name>
</author>
<author>
<name sortKey="Roghmann, F" uniqKey="Roghmann F">F Roghmann</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Ehlert, M" uniqKey="Ehlert M">M Ehlert</name>
</author>
<author>
<name sortKey="Sun, M" uniqKey="Sun M">M Sun</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Abaza, R" uniqKey="Abaza R">R Abaza</name>
</author>
<author>
<name sortKey="Ghani, Kr" uniqKey="Ghani K">KR Ghani</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Ahlawat, R" uniqKey="Ahlawat R">R Ahlawat</name>
</author>
<author>
<name sortKey="Kumar, Rk" uniqKey="Kumar R">RK Kumar</name>
</author>
<author>
<name sortKey="Jeong, W" uniqKey="Jeong W">W Jeong</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Menon, M" uniqKey="Menon M">M Menon</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Bhandari, M" uniqKey="Bhandari M">M Bhandari</name>
</author>
<author>
<name sortKey="Kher, V" uniqKey="Kher V">V Kher</name>
</author>
<author>
<name sortKey="Ghosh, P" uniqKey="Ghosh P">P Ghosh</name>
</author>
<author>
<name sortKey="Abaza, R" uniqKey="Abaza R">R Abaza</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Giulianotti, P" uniqKey="Giulianotti P">P Giulianotti</name>
</author>
<author>
<name sortKey="Gorodner, V" uniqKey="Gorodner V">V Gorodner</name>
</author>
<author>
<name sortKey="Sbrana, F" uniqKey="Sbrana F">F Sbrana</name>
</author>
<author>
<name sortKey="Tzvetanov, I" uniqKey="Tzvetanov I">I Tzvetanov</name>
</author>
<author>
<name sortKey="Jeon, H" uniqKey="Jeon H">H Jeon</name>
</author>
<author>
<name sortKey="Bianco, F" uniqKey="Bianco F">F Bianco</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Bahler, Cd" uniqKey="Bahler C">CD Bahler</name>
</author>
<author>
<name sortKey="Sundaram, Cp" uniqKey="Sundaram C">CP Sundaram</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lee, Jy" uniqKey="Lee J">JY Lee</name>
</author>
<author>
<name sortKey="Mucksavage, P" uniqKey="Mucksavage P">P Mucksavage</name>
</author>
<author>
<name sortKey="Sundaram, Cp" uniqKey="Sundaram C">CP Sundaram</name>
</author>
<author>
<name sortKey="Mcdougall, Em" uniqKey="Mcdougall E">EM McDougall</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mcculloch, P" uniqKey="Mcculloch P">P McCulloch</name>
</author>
<author>
<name sortKey="Cook, Ja" uniqKey="Cook J">JA Cook</name>
</author>
<author>
<name sortKey="Altman, Dg" uniqKey="Altman D">DG Altman</name>
</author>
<author>
<name sortKey="Heneghan, C" uniqKey="Heneghan C">C Heneghan</name>
</author>
<author>
<name sortKey="Diener, Mk" uniqKey="Diener M">MK Diener</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Menon, M" uniqKey="Menon M">M Menon</name>
</author>
<author>
<name sortKey="Abaza, R" uniqKey="Abaza R">R Abaza</name>
</author>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Ahlawat, R" uniqKey="Ahlawat R">R Ahlawat</name>
</author>
<author>
<name sortKey="Ghani, Kr" uniqKey="Ghani K">KR Ghani</name>
</author>
<author>
<name sortKey="Jeong, W" uniqKey="Jeong W">W Jeong</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Hopper, An" uniqKey="Hopper A">AN Hopper</name>
</author>
<author>
<name sortKey="Jamison, Mh" uniqKey="Jamison M">MH Jamison</name>
</author>
<author>
<name sortKey="Lewis, Wg" uniqKey="Lewis W">WG Lewis</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Abboudi, H" uniqKey="Abboudi H">H Abboudi</name>
</author>
<author>
<name sortKey="Khan, Ms" uniqKey="Khan M">MS Khan</name>
</author>
<author>
<name sortKey="Guru, Ka" uniqKey="Guru K">KA Guru</name>
</author>
<author>
<name sortKey="Froghi, S" uniqKey="Froghi S">S Froghi</name>
</author>
<author>
<name sortKey="De Win, G" uniqKey="De Win G">G de Win</name>
</author>
<author>
<name sortKey="Van Poppel, H" uniqKey="Van Poppel H">H Van Poppel</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Sood, A" uniqKey="Sood A">A Sood</name>
</author>
<author>
<name sortKey="Ghani, Kr" uniqKey="Ghani K">KR Ghani</name>
</author>
<author>
<name sortKey="Ahlawat, R" uniqKey="Ahlawat R">R Ahlawat</name>
</author>
<author>
<name sortKey="Modi, P" uniqKey="Modi P">P Modi</name>
</author>
<author>
<name sortKey="Abaza, R" uniqKey="Abaza R">R Abaza</name>
</author>
<author>
<name sortKey="Jeong, W" uniqKey="Jeong W">W Jeong</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Yule, S" uniqKey="Yule S">S Yule</name>
</author>
<author>
<name sortKey="Rowley, D" uniqKey="Rowley D">D Rowley</name>
</author>
<author>
<name sortKey="Flin, R" uniqKey="Flin R">R Flin</name>
</author>
<author>
<name sortKey="Maran, N" uniqKey="Maran N">N Maran</name>
</author>
<author>
<name sortKey="Youngson, G" uniqKey="Youngson G">G Youngson</name>
</author>
<author>
<name sortKey="Duncan, J" uniqKey="Duncan J">J Duncan</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Thiel, Dd" uniqKey="Thiel D">DD Thiel</name>
</author>
<author>
<name sortKey="Lannen, A" uniqKey="Lannen A">A Lannen</name>
</author>
<author>
<name sortKey="Richie, E" uniqKey="Richie E">E Richie</name>
</author>
<author>
<name sortKey="Dove, J" uniqKey="Dove J">J Dove</name>
</author>
<author>
<name sortKey="Gajarawala, Nm" uniqKey="Gajarawala N">NM Gajarawala</name>
</author>
<author>
<name sortKey="Igel, Tc" uniqKey="Igel T">TC Igel</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Eddy, Dm" uniqKey="Eddy D">DM Eddy</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Lendvay, Ts" uniqKey="Lendvay T">TS Lendvay</name>
</author>
<author>
<name sortKey="Brand, Tc" uniqKey="Brand T">TC Brand</name>
</author>
<author>
<name sortKey="White, L" uniqKey="White L">L White</name>
</author>
<author>
<name sortKey="Kowalewski, T" uniqKey="Kowalewski T">T Kowalewski</name>
</author>
<author>
<name sortKey="Jonnadula, S" uniqKey="Jonnadula S">S Jonnadula</name>
</author>
<author>
<name sortKey="Mercer, Ld" uniqKey="Mercer L">LD Mercer</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Shepherd, W" uniqKey="Shepherd W">W Shepherd</name>
</author>
<author>
<name sortKey="Arora, Ks" uniqKey="Arora K">KS Arora</name>
</author>
<author>
<name sortKey="Abboudi, H" uniqKey="Abboudi H">H Abboudi</name>
</author>
<author>
<name sortKey="Shamim, Khan M" uniqKey="Shamim K">Khan M Shamim</name>
</author>
<author>
<name sortKey="Dasgupta, P" uniqKey="Dasgupta P">P Dasgupta</name>
</author>
<author>
<name sortKey="Ahmed, K" uniqKey="Ahmed K">K Ahmed</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Skinner, Bf" uniqKey="Skinner B">BF Skinner</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Forster, Ja" uniqKey="Forster J">JA Forster</name>
</author>
<author>
<name sortKey="Browning, Aj" uniqKey="Browning A">AJ Browning</name>
</author>
<author>
<name sortKey="Paul, Ab" uniqKey="Paul A">AB Paul</name>
</author>
<author>
<name sortKey="Biyani, Cs" uniqKey="Biyani C">CS Biyani</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Le, Cq" uniqKey="Le C">CQ Le</name>
</author>
<author>
<name sortKey="Lightner, Dj" uniqKey="Lightner D">DJ Lightner</name>
</author>
<author>
<name sortKey="Vanderlei, L" uniqKey="Vanderlei L">L VanderLei</name>
</author>
<author>
<name sortKey="Segura, Jw" uniqKey="Segura J">JW Segura</name>
</author>
<author>
<name sortKey="Gettman, Mt" uniqKey="Gettman M">MT Gettman</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Hay, D" uniqKey="Hay D">D Hay</name>
</author>
<author>
<name sortKey="Khan, Ms" uniqKey="Khan M">MS Khan</name>
</author>
<author>
<name sortKey="Van Poppel, H" uniqKey="Van Poppel H">H Van Poppel</name>
</author>
<author>
<name sortKey="Van Cleynenbreugel, B" uniqKey="Van Cleynenbreugel B">B Van Cleynenbreugel</name>
</author>
<author>
<name sortKey="Peabody, J" uniqKey="Peabody J">J Peabody</name>
</author>
<author>
<name sortKey="Guru, K" uniqKey="Guru K">K Guru</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Mcdougall, Em" uniqKey="Mcdougall E">EM McDougall</name>
</author>
<author>
<name sortKey="Corica, Fa" uniqKey="Corica F">FA Corica</name>
</author>
<author>
<name sortKey="Chou, Ds" uniqKey="Chou D">DS Chou</name>
</author>
<author>
<name sortKey="Abdelshehid, Cs" uniqKey="Abdelshehid C">CS Abdelshehid</name>
</author>
<author>
<name sortKey="Uribe, Ca" uniqKey="Uribe C">CA Uribe</name>
</author>
<author>
<name sortKey="Stoliar, G" uniqKey="Stoliar G">G Stoliar</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Gamboa, Aj" uniqKey="Gamboa A">AJ Gamboa</name>
</author>
<author>
<name sortKey="Santos, Rt" uniqKey="Santos R">RT Santos</name>
</author>
<author>
<name sortKey="Sargent, Er" uniqKey="Sargent E">ER Sargent</name>
</author>
<author>
<name sortKey="Louie, Mk" uniqKey="Louie M">MK Louie</name>
</author>
<author>
<name sortKey="Box, Gn" uniqKey="Box G">GN Box</name>
</author>
<author>
<name sortKey="Sohn, Kh" uniqKey="Sohn K">KH Sohn</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Patel, Sr" uniqKey="Patel S">SR Patel</name>
</author>
<author>
<name sortKey="Hedican, Sp" uniqKey="Hedican S">SP Hedican</name>
</author>
<author>
<name sortKey="Bishoff, Jt" uniqKey="Bishoff J">JT Bishoff</name>
</author>
<author>
<name sortKey="Shichman, Sj" uniqKey="Shichman S">SJ Shichman</name>
</author>
<author>
<name sortKey="Link, Re" uniqKey="Link R">RE Link</name>
</author>
<author>
<name sortKey="Wolf, Js" uniqKey="Wolf J">JS Wolf</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Herron, Dm" uniqKey="Herron D">DM Herron</name>
</author>
<author>
<name sortKey="Marohn, M" uniqKey="Marohn M">M Marohn</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Goh, Ac" uniqKey="Goh A">AC Goh</name>
</author>
<author>
<name sortKey="Goldfarb, Dw" uniqKey="Goldfarb D">DW Goldfarb</name>
</author>
<author>
<name sortKey="Sander, Jc" uniqKey="Sander J">JC Sander</name>
</author>
<author>
<name sortKey="Miles, Bj" uniqKey="Miles B">BJ Miles</name>
</author>
<author>
<name sortKey="Dunkin, Bj" uniqKey="Dunkin B">BJ Dunkin</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="review-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Minim Access Surg</journal-id>
<journal-id journal-id-type="iso-abbrev">J Minim Access Surg</journal-id>
<journal-id journal-id-type="publisher-id">JMAS</journal-id>
<journal-title-group>
<journal-title>Journal of Minimal Access Surgery</journal-title>
</journal-title-group>
<issn pub-type="ppub">0972-9941</issn>
<issn pub-type="epub">1998-3921</issn>
<publisher>
<publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">25598593</article-id>
<article-id pub-id-type="pmc">4290108</article-id>
<article-id pub-id-type="publisher-id">JMAS-11-10</article-id>
<article-id pub-id-type="doi">10.4103/0972-9941.147662</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Review Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Robotic surgical skill acquisition: What one needs to know?</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Sood</surname>
<given-names>Akshay</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jeong</surname>
<given-names>Wooju</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ahlawat</surname>
<given-names>Rajesh</given-names>
</name>
<xref ref-type="aff" rid="aff2">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Campbell</surname>
<given-names>Logan</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Aggarwal</surname>
<given-names>Shruti</given-names>
</name>
<xref ref-type="aff" rid="aff3">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Menon</surname>
<given-names>Mani</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bhandari</surname>
<given-names>Mahendra</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
</contrib-group>
<aff id="aff1">Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA</aff>
<aff id="aff2">
<label>1</label>
Kidney and Urology Institute, Medanta — The Medicity, Gurgaon, India</aff>
<aff id="aff3">
<label>2</label>
Department of Medicine, Metrowest Medical Center, Framingham, MA, USA</aff>
<author-notes>
<corresp id="cor1">
<bold>Address for Correspondence:</bold>
Dr. Akshay Sood, Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, Michigan, USA, 48202. E-mail:
<email xlink:href="asood1@hfhs.org">asood1@hfhs.org</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<season>Jan-Mar</season>
<year>2015</year>
</pub-date>
<volume>11</volume>
<issue>1</issue>
<fpage>10</fpage>
<lpage>15</lpage>
<history>
<date date-type="received">
<day>25</day>
<month>9</month>
<year>2014</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>9</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright: © Journal of Minimal Access Surgery</copyright-statement>
<copyright-year>2015</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<p>Robotic surgery has been eagerly adopted by patients and surgeons alike in the field of urology, over the last decade. However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Accordingly, in this review, we aim to highlight ‘who’ needs to learn ‘what’ and ‘how’, to become competent in robotic surgery. We demonstrate that both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. With regard to training curricula, a variety of training programs such as academic fellowships, mini-fellowships, and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons adequately. Fellowships provide the most comprehensive training, however, may not be suitable to all surgeon-learners secondary to the long-term time commitment. For these surgeon-learners short-term courses such as the mini-fellowships or mentored skill courses might be more apt. Lastly, with regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.</p>
</abstract>
<kwd-group>
<kwd>Curriculum</kwd>
<kwd>robotics</kwd>
<kwd>simulation</kwd>
<kwd>surgical learning</kwd>
<kwd>training</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec1-1">
<title>INTRODUCTION</title>
<p>Minimally-invasive surgery (MIS) began in the year 1987 with laparoscopic cholecystectomy.[
<xref rid="ref1" ref-type="bibr">1</xref>
] The advantages and disadvantages of the MIS approach became quickly apparent. The advantages included decreased surgical site infection, blood loss and postoperative pain, shorter hospital stay, and better cosmesis. On the other hand, the disadvantages included loss of haptic feedback and hand-eye coordination.[
<xref rid="ref2" ref-type="bibr">2</xref>
] These limitations made delicate dissections and anastomoses difficult if not impossible.[
<xref rid="ref3" ref-type="bibr">3</xref>
] Robotic surgery was, thus, developed to overcome these limitations of the MIS and to enhance the capabilities of surgeons performing open surgery.[
<xref rid="ref2" ref-type="bibr">2</xref>
]</p>
<p>Robotic surgery, over the last decade, has been enthusiastically adopted by patients and surgeons alike in the field of urology, and today, is utilized for oncological,[
<xref rid="ref4" ref-type="bibr">4</xref>
<xref rid="ref5" ref-type="bibr">5</xref>
<xref rid="ref6" ref-type="bibr">6</xref>
] reconstructive,[
<xref rid="ref7" ref-type="bibr">7</xref>
<xref rid="ref8" ref-type="bibr">8</xref>
] pediatric,[
<xref rid="ref9" ref-type="bibr">9</xref>
<xref rid="ref10" ref-type="bibr">10</xref>
<xref rid="ref11" ref-type="bibr">11</xref>
] urogynecological,[
<xref rid="ref12" ref-type="bibr">12</xref>
] and kidney transplantation procedures.[
<xref rid="ref13" ref-type="bibr">13</xref>
<xref rid="ref14" ref-type="bibr">14</xref>
<xref rid="ref15" ref-type="bibr">15</xref>
] However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Although, there have been institutional and surgical-societal level efforts at standardization of these processes, so far these efforts have met with limited success and heterogeneity in certification standards persists.[
<xref rid="ref16" ref-type="bibr">16</xref>
<xref rid="ref17" ref-type="bibr">17</xref>
<xref rid="ref18" ref-type="bibr">18</xref>
] Hence, as adoption of robotic surgery continues to increase, there is an urgent need for unifying the training and credentialing requirements to ensure patient safety. Accordingly, in this review, we aim to highlight ‘who’ needs to learn ‘what’ and ‘how’, to become competent in robotic surgery.</p>
<sec id="sec2-1">
<title>Who Needs to Learn?</title>
<p>Learning is an essential part of skill acquisition and of surgical apprenticeship. During the learning process, however, there is an increased propensity for error, and in the setting of clinical practice this may or may not be acceptable depending on the risk involved. A learning curve can exist in two situations in surgical practice [
<xref ref-type="fig" rid="F1">Figure 1a</xref>
]:</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption>
<p>(a) Two types of learning scenarios in surgery; (b) The classic phases of a learning curve – learning phase, competency, proficiency and mastery (non-CUSUM learning curve)</p>
</caption>
<graphic xlink:href="JMAS-11-10-g001"></graphic>
</fig>
<p>
<list list-type="bullet">
<list-item>
<p>When a novice surgeon learns an established procedure under supervision (surgical apprenticeship).</p>
</list-item>
<list-item>
<p>When a pioneering surgeon seeks to innovate and develop a new technique (surgical innovation).</p>
</list-item>
</list>
</p>
<p>In both of the aforementioned scenarios, the patient maybe at an increased risk for adverse outcome; however, the former situation represents by far the more common setting, albeit a less risky one. Further, the precautions to counter the increased risk in both these scenarios vary vastly. For example, in the case of surgical innovation the pathway to ensure patient safety is to perform preclinical (animal/cadaveric) feasibility and simulator studies before performing patient surgery.[
<xref rid="ref19" ref-type="bibr">19</xref>
<xref rid="ref20" ref-type="bibr">20</xref>
] While on the other hand, the usual pathway for ensuring uncompromised patient outcomes during training of a novice surgeon includes theoretical learning and mentoring, although occasionally simulator/animal studies maybe utilized. In the current review, we will limit the discussion to the latter learning pathway (surgical apprenticeship), as it is the primary topic of interest to this review.</p>
<p>To address the concern of training a novice surgeon, mentors/credentialing committees have traditionally relied on learning curves[
<xref rid="ref21" ref-type="bibr">21</xref>
<xref rid="ref22" ref-type="bibr">22</xref>
] which help estimate the number of cases a surgeon-learner must perform under supervision to become competent (and avoid compromising patient outcomes). An ideal learning curve is shown in
<xref ref-type="fig" rid="F1">Figure 1b</xref>
. Each new task a novice surgeon acquires will have an associated learning curve. Depending on the magnitude of difference in the tasks being learnt, the surgeon may or may not need supervision for each new task. For example, if a surgeon has learnt to perform iliac vessel anastomoses, he should presumably be competent to perform anastomoses of other similar-sized blood vessels without supervision. While on the other hand, if a surgeon has learnt to perform iliac vessel anastomoses via open surgery would he be capable of performing the same via robotic surgery without supervision? Does he need to learn anything?</p>
<p>These questions are applicable to the case of experienced open surgeons adopting robotic surgery. The answer to the earlier-given questions lie in distinguishing between domain knowledge and technical knowledge (please see the next section). Many open surgeons hold the notion that secondary to their acclimation with the open surgical technique they will be able to perform the same given task equally well robotically. However, recently, it has been shown that skilled open surgeons adopting robotic surgery have a substantial learning phase that varies with the task being learnt. Specifically, in the study of robotic kidney transplantation (RKT) with regional hypothermia, three surgeon groups were evaluated with varying open and robotic experience/training.[
<xref rid="ref23" ref-type="bibr">23</xref>
] Group-1: robotic trained with limited kidney transplantation (KT) experience (patients=7); Group-2: robotic trained and KT experienced (patients=20); and Group-3: KT experienced with limited robotic training (patients=14). It was demonstrated that for surgeons in group 1 and 2, there was a minimal-to-nil learning phase. However, for group 3 there was a significant learning phase. Learning phase lasted until case 9 and 12 for venous and arterial anastomoses, respectively [Figures
<xref ref-type="fig" rid="F2">2a</xref>
and
<xref ref-type="fig" rid="F2">b</xref>
]. Similarly, for the ureterovesical anastomosis, the learning phase continued beyond patient 14 [
<xref ref-type="fig" rid="F2">Figure 2c</xref>
]* and for re-warming time, competency was achieved after case 11 [
<xref ref-type="fig" rid="F2">Figure 2d</xref>
]. For graft function, the learning phase was short, and competency and mastery were achieved after case 3 and 13, respectively [Figures
<xref ref-type="fig" rid="F3">3a</xref>
and
<xref ref-type="fig" rid="F3">b</xref>
]. Hence, there is a clear role of mentoring and/or precepting in even the experienced open surgeons during early phases of the adoption of robotic technology to ensure patient safety.[
<xref rid="ref23" ref-type="bibr">23</xref>
]</p>
<fig id="F2" position="float">
<label>Figure 2</label>
<caption>
<p>Learning curve assessment using CUSUM method for technical outcomes. (a) for venous anastomosis; (b) for arterial anastomosis; (c) for uretero-vesical anastomosis; (d) for re-warming time (Reproduced with permission from Elsevier Inc., European Urology; 2014 Mar 4; Application of the Statistical Process Control Method for Prospective Patient Safety Monitoring During the Learning Phase: Robotic Kidney Transplantation with Regional Hypothermia [IDEAL Phase 2a-b]; Sood
<italic>et al</italic>
.)</p>
</caption>
<graphic xlink:href="JMAS-11-10-g002"></graphic>
</fig>
<fig id="F3" position="float">
<label>Figure 3</label>
<caption>
<p>Learning curve assessment using CUSUM method for functional outcomes. (a) for POD 7 serum creatinine; (b) for POD 7 estimated GFR (Reproduced with permission from Elsevier Inc., European Urology; 2014 Mar 4; Application of the Statistical Process Control Method for Prospective Patient Safety Monitoring During the Learning Phase: Robotic Kidney Transplantation with Regional Hypothermia [IDEAL Phase 2a-b]; Sood
<italic>et al</italic>
.)</p>
</caption>
<graphic xlink:href="JMAS-11-10-g003"></graphic>
</fig>
<p>[The graphs are cumulative summation (CUSUM) derived learning curves, for details on methodology and how to interpret them accurately please refer to the original text, but essentially the plateau denotes the end of learning phase].[
<xref rid="ref23" ref-type="bibr">23</xref>
]</p>
<p>Lastly, in robotic surgery, in addition to training of the surgeon there is a clear place for learning of the skill by the team as a whole.[
<xref rid="ref24" ref-type="bibr">24</xref>
] Thiel
<italic>et al</italic>
.[
<xref rid="ref25" ref-type="bibr">25</xref>
] in their study of robotic prostatectomy evaluated the role of training bedside assistants — in this study, the participants underwent a three-phase learning course including teaching regarding the basics of robot functionality (phase-1), a step-by-step video showing the optimal role of an assistant during robotic prostatectomy (phase-2), and lastly, a hands-on practice session (phase-3). The authors noted that all 13 participants who underwent the 3-phase learning course recorded improved spatial orientation during surgery and felt that the training made them a better assistant (100% response rate). The module that was most useful was the ‘hands-on’ drill. Hence, while setting up a robotic surgery program, it might be worthwhile to keep in consideration the training of assistants to further improve patient outcomes.</p>
</sec>
<sec id="sec2-2">
<title>What Needs to be Learned and when?</title>
<p>For successful performance of any task a person needs to have the knowhow of what to do (domain knowledge) and how to do it (technical knowledge;
<xref ref-type="fig" rid="F4">Figure 4</xref>
), as David Eddy pointed out in his landmark paper.[
<xref rid="ref26" ref-type="bibr">26</xref>
] Domain knowledge, also alluded to as functional knowledge sometimes, refers to the understanding of a concept while technical knowledge represents the acquaintance of an individual with the steps in execution of a task. Domain knowledge is primarily acquired from theory whereas technical knowledge is acquired by practice. We briefly alluded to these concepts in the previous section, and using the same example, we highlight that the reason why open surgeons cannot transition into robotic surgery without going through a learning phase is because of lack of technical knowledge. An experienced open surgeon possesses the domain knowledge, but to achieve competency in technical knowledge — the surgeon needs to practice either in a simulated environment or under mentorship in a clinical environment, much akin to training of a novice surgeon. However, a resident/fellow learning a robotic procedure will need to acquire both domain and technical knowledge.</p>
<fig id="F4" position="float">
<label>Figure 4</label>
<caption>
<p>The two types of knowledge required for successful execution of a task</p>
</caption>
<graphic xlink:href="JMAS-11-10-g004"></graphic>
</fig>
<p>Lastly, the time to learn is also important when acquiring a new technical skill, as prior studies show.[
<xref rid="ref27" ref-type="bibr">27</xref>
] We humbly submit that open surgeons should only consider taking robotic training modules when they have the desire and the setup to perform robotic surgery on a regular basis, as many of the courses (detailed in next section) offer short-term training, can be expensive and might not leave a lasting impression unless robotic surgery in continued afterwards.</p>
</sec>
<sec id="sec2-3">
<title>How can it be Learned? And When Can a New Skill Be Considered Learned?</title>
<p>An ideal curriculum for teaching technical skills (technical knowledge) requires, foremost, setting of clear goals and objectives that can be achieved by trainees with the help of targeted interventions. The next crucial step is designing and incorporating these interventions along with assessment tools that can certify the surgeon-learner's competency.[
<xref rid="ref28" ref-type="bibr">28</xref>
] Assessment is a critical part of learning, not only because it ensures surgeon competence but also because it helps learning by the virtue of feedback (operant conditioning).[
<xref rid="ref29" ref-type="bibr">29</xref>
]</p>
<p>As stated previously, there have been several institutional and surgical-societal level efforts to develop and standardize the training curriculum and certification requirements in minimally-invasive surgical training. Although, these processes have met with limited success so far, the hospitals, credentialing committees/associations and program directors are increasingly recognizing the need for formal MIS training and credentialing, and the adoption of these processes is increasing.[
<xref rid="ref17" ref-type="bibr">17</xref>
<xref rid="ref18" ref-type="bibr">18</xref>
<xref rid="ref30" ref-type="bibr">30</xref>
<xref rid="ref31" ref-type="bibr">31</xref>
] Further, with regards to certification — there has been a tremendous overhaul in the way competency is evaluated. Traditionally, a trainee's competence was measured based on time-based apprentice-type system where time spent within a specialty was the defining factor in skill acquisition. However, in the contemporary system a trainee's progress is determined by instating specific benchmarks for him/her to achieve which lead to more objective and evidence-based credentialing.[
<xref rid="ref28" ref-type="bibr">28</xref>
]</p>
<p>
<xref ref-type="table" rid="T1">Table 1</xref>
details the various training programs that exist for training surgeons in robotic surgery. The current generation of resident surgeons has some degree of robotic experience (at least in the United States). However, mostly the experience is insufficient to warrant independent practice. Hence, the training programs described in the following are applicable to all surgeons with varying degrees of open/laparoscopic/robotic surgical experience. There are primarily three types of training programs (curricula):[
<xref rid="ref32" ref-type="bibr">32</xref>
]</p>
<table-wrap id="T1" position="float">
<label>Table 1</label>
<caption>
<p>Various training curricula for acquiring minimally invasive surgical skills</p>
</caption>
<graphic xlink:href="JMAS-11-10-g005"></graphic>
</table-wrap>
<p>
<list list-type="bullet">
<list-item>
<p>Fellowships.</p>
</list-item>
<list-item>
<p>Mini-fellowships.</p>
</list-item>
<list-item>
<p>Mentored skills courses.</p>
</list-item>
</list>
</p>
<p>Depending on the time a surgeon can devote for training and the desired level of learning intended, one of the aforementioned courses might be more suitable. A fellowship is the most comprehensive course which includes one-to-one mentoring, precepting, and teaching in both simulated and clinical environments. The training duration usually ranges between 1 to 2 years. However, a fellowship might not be suitable for most post-graduate surgeons due to time constraints. A mini-fellowship or a mentored skills course maybe more ideal in this situation. A mini-fellowship (developed at the University of California Irvine, USA) is a 5 day teaching and mentor-mentee course during which the mentee's attends didactic sessions, live OR-cases, and hands-on lab sessions.[
<xref rid="ref33" ref-type="bibr">33</xref>
<xref rid="ref34" ref-type="bibr">34</xref>
] Whereas, the mentored skills course combines online learning with a 2-day mentored course.[
<xref rid="ref32" ref-type="bibr">32</xref>
<xref rid="ref35" ref-type="bibr">35</xref>
] Both of these programs have been demonstrated to have excellent content and construct validity; however, the performance predictive validity has not been evaluated.[
<xref rid="ref17" ref-type="bibr">17</xref>
<xref rid="ref28" ref-type="bibr">28</xref>
] Further, despite the short duration of the latter two courses, approximately 70-80% of the trainees successfully transition to robotic surgery, and are regularly practicing it at 3 years post-training.[
<xref rid="ref18" ref-type="bibr">18</xref>
<xref rid="ref32" ref-type="bibr">32</xref>
] Lastly, somewhat related to this topic is the Food and Drug Administration (FDA) mandated basic robot-handling training required for all surgeons performing robot-assisted procedures. The FDA training necessitates the knowhow on how to safely and rapidly remove the device in an emergency, what to do if the system stops responding, and how to respond if the system makes movements that are potentially unsafe to the patient. This training is offered by the Institutive Surgical Inc.[
<xref rid="ref36" ref-type="bibr">36</xref>
]</p>
<p>The guidelines on credentialing for robotic competency are more opaque at this time and vary from institution to institution.[
<xref rid="ref18" ref-type="bibr">18</xref>
] Currently, most commonly, the surgeon-learner is subjectively assessed by the mentor (proctoring), which might be an acceptable way of evaluation over the long-term mentor-mentee relationship during a fellowship, however, may not represent a valid method of assessment during the short-term courses. Accordingly, there are certain tools such as the global evaluative assessment of robotic skills (GEARS)[
<xref rid="ref37" ref-type="bibr">37</xref>
] which permit objective assessment and can be used to grade performance during simulation exercises. However, there is a lack of consensus on what the cutoffs for competency, proficiency and mastery should be (the different phases of a learning curve;
<xref ref-type="fig" rid="F1">Figure 1B</xref>
). We believe that these cutoffs need to be devised based on consensus-performance of experienced surgeons according to the GEARS tool at a multi-institutional level.</p>
<p>Further, more recently, in the study of RKT with regional hypothermia, referred to previously[
<xref rid="ref23" ref-type="bibr">23</xref>
] — the authors described a novel method of assessing competence by evaluating learning curves
<italic>prospectively</italic>
,
<italic>objectively</italic>
at an
<italic>individual</italic>
level utilizing cutoffs based on outcomes from previous kidney transplant series. By setting a target value (for technical [operative/anastomoses times] and functional [graft function] outcomes) prospectively and utilizing the mathematical cumulative summation (CUSUM) method, allowed the authors to evaluate the learning curve for each surgeon-learner continuously, objectively, and prospectively. This in turn permitted competency declaration at an individual level instead of utilizing an arbitrary cutoff of a standard number of cases for each surgeon-learner irrespective of their learning capabilities and training background. This methodology, theoretically speaking, combined with GEARS-cutoffs derived from experienced surgeons (as proposed earlier) can be used to monitor learning curves of surgeon-learners adopting robotic surgery continuously and prospectively during simulation training, and might allow recommendations regarding their learning status to be made in a more objective and individualized manner.</p>
</sec>
</sec>
<sec sec-type="conclusion" id="sec1-2">
<title>CONCLUSION</title>
<p>In conclusion, both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. A variety of training programs such as academic fellowships, mini-fellowships and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons thoroughly and adequately. With regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="supported-by">
<p>
<bold>Source of Support:</bold>
Nil</p>
</fn>
<fn fn-type="conflict">
<p>
<bold>Conflict of Interest:</bold>
None declared.</p>
</fn>
</fn-group>
<ref-list>
<title>REFERENCES</title>
<ref id="ref1">
<label>1</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Polychronidis</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Laftsidis</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Bounovas</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Simopoulos</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Twenty years of laparoscopic cholecystectomy: Philippe Mouret--March 17, 1987</article-title>
<source>JSLS</source>
<year>2008</year>
<volume>12</volume>
<fpage>109</fpage>
<lpage>11</lpage>
<pub-id pub-id-type="pmid">18402752</pub-id>
</element-citation>
</ref>
<ref id="ref2">
<label>2</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Jeong</surname>
<given-names>W</given-names>
</name>
<name>
<surname>Peabody</surname>
<given-names>JO</given-names>
</name>
<name>
<surname>Hemal</surname>
<given-names>AK</given-names>
</name>
<name>
<surname>Menon</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Robot-Assisted Radical Prostatectomy: Inching Toward Gold Standard</article-title>
<source>Urol Clin North Am</source>
<year>2014</year>
<volume>41</volume>
<fpage>473</fpage>
<lpage>84</lpage>
<pub-id pub-id-type="pmid">25306159</pub-id>
</element-citation>
</ref>
<ref id="ref3">
<label>3</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lanfranco</surname>
<given-names>AR</given-names>
</name>
<name>
<surname>Castellanos</surname>
<given-names>AE</given-names>
</name>
<name>
<surname>Desai</surname>
<given-names>JP</given-names>
</name>
<name>
<surname>Meyers</surname>
<given-names>WC</given-names>
</name>
</person-group>
<article-title>Robotic surgery: A current perspective</article-title>
<source>Ann Surg</source>
<year>2004</year>
<volume>239</volume>
<fpage>14</fpage>
<lpage>21</lpage>
<pub-id pub-id-type="pmid">14685095</pub-id>
</element-citation>
</ref>
<ref id="ref4">
<label>4</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hayn</surname>
<given-names>MH</given-names>
</name>
<name>
<surname>Hussain</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Mansour</surname>
<given-names>AM</given-names>
</name>
<name>
<surname>Andrews</surname>
<given-names>PE</given-names>
</name>
<name>
<surname>Carpentier</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Castle</surname>
<given-names>E</given-names>
</name>
<etal></etal>
</person-group>
<article-title>The learning curve of robot-assisted radical cystectomy: Results from the International Robotic Cystectomy Consortium</article-title>
<source>Eur Urol</source>
<year>2010</year>
<volume>58</volume>
<fpage>197</fpage>
<lpage>202</lpage>
<pub-id pub-id-type="pmid">20434830</pub-id>
</element-citation>
</ref>
<ref id="ref5">
<label>5</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sukumar</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Rogers</surname>
<given-names>CG</given-names>
</name>
</person-group>
<article-title>Robotic partial nephrectomy: Surgical technique</article-title>
<source>BJU Int</source>
<year>2011</year>
<volume>108</volume>
<issue>6 Pt 2</issue>
<fpage>942</fpage>
<lpage>7</lpage>
<pub-id pub-id-type="pmid">21917095</pub-id>
</element-citation>
</ref>
<ref id="ref6">
<label>6</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Abaza</surname>
<given-names>R</given-names>
</name>
</person-group>
<article-title>Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy</article-title>
<source>Eur Urol</source>
<year>2011</year>
<volume>59</volume>
<fpage>652</fpage>
<lpage>6</lpage>
<pub-id pub-id-type="pmid">20846783</pub-id>
</element-citation>
</ref>
<ref id="ref7">
<label>7</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ghani</surname>
<given-names>KR</given-names>
</name>
<name>
<surname>Rogers</surname>
<given-names>CG</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Kumar</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Ehlert</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Jeong</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Robot-assisted anatrophic nephrolithotomy with renal hypothermia for managing staghorn calculi</article-title>
<source>J Endourol</source>
<year>2013</year>
<volume>27</volume>
<fpage>1393</fpage>
<lpage>8</lpage>
<pub-id pub-id-type="pmid">23859085</pub-id>
</element-citation>
</ref>
<ref id="ref8">
<label>8</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mufarrij</surname>
<given-names>PW</given-names>
</name>
<name>
<surname>Shah</surname>
<given-names>OD</given-names>
</name>
<name>
<surname>Berger</surname>
<given-names>AD</given-names>
</name>
<name>
<surname>Stifelman</surname>
<given-names>MD</given-names>
</name>
</person-group>
<article-title>Robotic reconstruction of the upper urinary tract</article-title>
<source>J Urol</source>
<year>2007</year>
<volume>178</volume>
<fpage>2002</fpage>
<lpage>5</lpage>
<pub-id pub-id-type="pmid">17869303</pub-id>
</element-citation>
</ref>
<ref id="ref9">
<label>9</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sammon</surname>
<given-names>JD</given-names>
</name>
<name>
<surname>Zhu</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Sukumar</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>SP</given-names>
</name>
<name>
<surname>Sun</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Pediatric nephrectomy: Incidence, indications and use of minimally invasive techniques</article-title>
<source>J Urol</source>
<year>2014</year>
<volume>191</volume>
<fpage>764</fpage>
<lpage>70</lpage>
<pub-id pub-id-type="pmid">24095907</pub-id>
</element-citation>
</ref>
<ref id="ref10">
<label>10</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sukumar</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Roghmann</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Abdo</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Menon</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Sammon</surname>
<given-names>JD</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Correction of Ureteropelvic Junction Obstruction in Children: National Trends and Comparative Effectiveness in Operative Outcomes</article-title>
<source>J Endourol</source>
<year>2014</year>
<volume>28</volume>
<fpage>592</fpage>
<lpage>8</lpage>
<pub-id pub-id-type="pmid">24372348</pub-id>
</element-citation>
</ref>
<ref id="ref11">
<label>11</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Peters</surname>
<given-names>CA</given-names>
</name>
</person-group>
<article-title>Robotically assisted surgery in pediatric urology</article-title>
<source>Urol Clin North Am</source>
<year>2004</year>
<volume>31</volume>
<fpage>743</fpage>
<lpage>52</lpage>
<pub-id pub-id-type="pmid">15474601</pub-id>
</element-citation>
</ref>
<ref id="ref12">
<label>12</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Sammon</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Roghmann</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Ehlert</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Sun</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse</article-title>
<source>Can Urol Assoc J</source>
<year>2014</year>
<volume>8</volume>
<fpage>100</fpage>
<lpage>6</lpage>
<pub-id pub-id-type="pmid">24839477</pub-id>
</element-citation>
</ref>
<ref id="ref13">
<label>13</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Abaza</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Ghani</surname>
<given-names>KR</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Ahlawat</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Kumar</surname>
<given-names>RK</given-names>
</name>
<name>
<surname>Jeong</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Robotic kidney transplantation with intraoperative regional hypothermia</article-title>
<source>BJU Int</source>
<year>2014</year>
<volume>113</volume>
<fpage>679</fpage>
<lpage>81</lpage>
<pub-id pub-id-type="pmid">24238345</pub-id>
</element-citation>
</ref>
<ref id="ref14">
<label>14</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Menon</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Bhandari</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Kher</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Ghosh</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Abaza</surname>
<given-names>R</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Robotic kidney transplantation with regional hypothermia: A Step-by-step Description of the Vattikuti Urology Institute-Medanta Technique (IDEAL Phase 2a)</article-title>
<source>Eur Urol</source>
<year>2014</year>
<volume>65</volume>
<fpage>991</fpage>
<lpage>1000</lpage>
<pub-id pub-id-type="pmid">24388099</pub-id>
</element-citation>
</ref>
<ref id="ref15">
<label>15</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Giulianotti</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Gorodner</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Sbrana</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Tzvetanov</surname>
<given-names>I</given-names>
</name>
<name>
<surname>Jeon</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Bianco</surname>
<given-names>F</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Robotic transabdominal kidney transplantation in a morbidly obese patient</article-title>
<source>Am J Transplant</source>
<year>2010</year>
<volume>10</volume>
<fpage>1478</fpage>
<lpage>82</lpage>
<pub-id pub-id-type="pmid">20486912</pub-id>
</element-citation>
</ref>
<ref id="ref16">
<label>16</label>
<element-citation publication-type="book">
<article-title>Small Sample Survey-Final report. Topic: da Vinci Surgical System</article-title>
<year>2013</year>
<date-in-citation>Last accessed on 2014 Sep 4</date-in-citation>
<publisher-name>US Food and Drug Administration, Centers for Devices and Radiological Health</publisher-name>
<comment>Available from:
<uri xlink:type="simple" xlink:href="http://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/surgeryandlifesupport/computerassistedroboticsurgicalsystems/ucm374095.pdf">http://www.fda.gov/downloads/ medicaldevices/productsandmedicalprocedures/surgeryandlifesupport/computerassistedroboticsurgicalsystems/ucm374095.pdf</uri>
</comment>
</element-citation>
</ref>
<ref id="ref17">
<label>17</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bahler</surname>
<given-names>CD</given-names>
</name>
<name>
<surname>Sundaram</surname>
<given-names>CP</given-names>
</name>
</person-group>
<article-title>Training in Robotic Surgery: Simulators, Surgery, and Credentialing</article-title>
<source>Urol Clin North Am</source>
<year>2014</year>
<volume>41</volume>
<fpage>581</fpage>
<lpage>89</lpage>
<pub-id pub-id-type="pmid">25306169</pub-id>
</element-citation>
</ref>
<ref id="ref18">
<label>18</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lee</surname>
<given-names>JY</given-names>
</name>
<name>
<surname>Mucksavage</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Sundaram</surname>
<given-names>CP</given-names>
</name>
<name>
<surname>McDougall</surname>
<given-names>EM</given-names>
</name>
</person-group>
<article-title>Best practices for robotic surgery training and credentialing</article-title>
<source>J Urol</source>
<year>2011</year>
<volume>185</volume>
<fpage>1191</fpage>
<lpage>7</lpage>
<pub-id pub-id-type="pmid">21334030</pub-id>
</element-citation>
</ref>
<ref id="ref19">
<label>19</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>McCulloch</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Cook</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Altman</surname>
<given-names>DG</given-names>
</name>
<name>
<surname>Heneghan</surname>
<given-names>C</given-names>
</name>
<name>
<surname>Diener</surname>
<given-names>MK</given-names>
</name>
</person-group>
<article-title>IDEAL Group. IDEAL framework for surgical innovation 1: The idea and development stages</article-title>
<source>BMJ</source>
<year>2013</year>
<volume>346</volume>
<fpage>f3012</fpage>
<pub-id pub-id-type="pmid">23778427</pub-id>
</element-citation>
</ref>
<ref id="ref20">
<label>20</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Menon</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Abaza</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Ahlawat</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Ghani</surname>
<given-names>KR</given-names>
</name>
<name>
<surname>Jeong</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Robotic Kidney Transplantation with Regional Hypothermia: Evolution of a Novel Procedure Utilizing the IDEAL Guidelines (IDEAL Phase 0 and 1)</article-title>
<source>Eur Urol</source>
<year>2014</year>
<volume>65</volume>
<fpage>1001</fpage>
<lpage>9</lpage>
<pub-id pub-id-type="pmid">24287316</pub-id>
</element-citation>
</ref>
<ref id="ref21">
<label>21</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hopper</surname>
<given-names>AN</given-names>
</name>
<name>
<surname>Jamison</surname>
<given-names>MH</given-names>
</name>
<name>
<surname>Lewis</surname>
<given-names>WG</given-names>
</name>
</person-group>
<article-title>Learning curves in surgical practice</article-title>
<source>Postgrad Med J</source>
<year>2007</year>
<volume>83</volume>
<fpage>777</fpage>
<lpage>9</lpage>
<pub-id pub-id-type="pmid">18057179</pub-id>
</element-citation>
</ref>
<ref id="ref22">
<label>22</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Abboudi</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Khan</surname>
<given-names>MS</given-names>
</name>
<name>
<surname>Guru</surname>
<given-names>KA</given-names>
</name>
<name>
<surname>Froghi</surname>
<given-names>S</given-names>
</name>
<name>
<surname>de Win</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Van Poppel</surname>
<given-names>H</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Learning curves for urological procedures: A systematic review</article-title>
<source>BJU Int</source>
<year>2013</year>
<comment>[In Press]</comment>
</element-citation>
</ref>
<ref id="ref23">
<label>23</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sood</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Ghani</surname>
<given-names>KR</given-names>
</name>
<name>
<surname>Ahlawat</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Modi</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Abaza</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Jeong</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Application of the Statistical Process Control Method for Prospective Patient Safety Monitoring During the Learning Phase: Robotic Kidney Transplantation with Regional Hypothermia (IDEAL Phase 2a-b)</article-title>
<source>Eur Urol</source>
<year>2014</year>
<volume>66</volume>
<fpage>371</fpage>
<lpage>8</lpage>
<pub-id pub-id-type="pmid">24631408</pub-id>
</element-citation>
</ref>
<ref id="ref24">
<label>24</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yule</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Rowley</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Flin</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Maran</surname>
<given-names>N</given-names>
</name>
<name>
<surname>Youngson</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Duncan</surname>
<given-names>J</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Experience matters: Comparing novice and expert ratings of non-technical skills using the NOTSS system</article-title>
<source>ANZ J Surg</source>
<year>2009</year>
<volume>79</volume>
<fpage>154</fpage>
<lpage>60</lpage>
<pub-id pub-id-type="pmid">19317781</pub-id>
</element-citation>
</ref>
<ref id="ref25">
<label>25</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Thiel</surname>
<given-names>DD</given-names>
</name>
<name>
<surname>Lannen</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Richie</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Dove</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Gajarawala</surname>
<given-names>NM</given-names>
</name>
<name>
<surname>Igel</surname>
<given-names>TC</given-names>
</name>
</person-group>
<article-title>Simulation-based training for bedside assistants can benefit experienced robotic prostatectomy teams</article-title>
<source>J Endourol</source>
<year>2013</year>
<volume>27</volume>
<fpage>230</fpage>
<lpage>7</lpage>
<pub-id pub-id-type="pmid">22849341</pub-id>
</element-citation>
</ref>
<ref id="ref26">
<label>26</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Eddy</surname>
<given-names>DM</given-names>
</name>
</person-group>
<article-title>Clinical decision making: From theory to practice. Anatomy of a decision</article-title>
<source>JAMA</source>
<year>1990</year>
<volume>263</volume>
<fpage>441</fpage>
<lpage>3</lpage>
<pub-id pub-id-type="pmid">2294311</pub-id>
</element-citation>
</ref>
<ref id="ref27">
<label>27</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lendvay</surname>
<given-names>TS</given-names>
</name>
<name>
<surname>Brand</surname>
<given-names>TC</given-names>
</name>
<name>
<surname>White</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Kowalewski</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Jonnadula</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Mercer</surname>
<given-names>LD</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Virtual reality robotic surgery warm-up improves task performance in a dry laboratory environment: A prospective randomized controlled study</article-title>
<source>J Am Coll Surg</source>
<year>2013</year>
<volume>216</volume>
<fpage>1181</fpage>
<lpage>92</lpage>
<pub-id pub-id-type="pmid">23583618</pub-id>
</element-citation>
</ref>
<ref id="ref28">
<label>28</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shepherd</surname>
<given-names>W</given-names>
</name>
<name>
<surname>Arora</surname>
<given-names>KS</given-names>
</name>
<name>
<surname>Abboudi</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Shamim</surname>
<given-names>Khan M</given-names>
</name>
<name>
<surname>Dasgupta</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Ahmed</surname>
<given-names>K</given-names>
</name>
</person-group>
<article-title>A review of the available urology skills training curricula and their validation</article-title>
<source>J Surg Educ</source>
<year>2014</year>
<volume>71</volume>
<fpage>289</fpage>
<lpage>96</lpage>
<pub-id pub-id-type="pmid">24797842</pub-id>
</element-citation>
</ref>
<ref id="ref29">
<label>29</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Skinner</surname>
<given-names>BF</given-names>
</name>
</person-group>
<article-title>Are theories of learning necessary?</article-title>
<source>Psychol Rev</source>
<year>1950</year>
<volume>57</volume>
<fpage>193</fpage>
<lpage>216</lpage>
<pub-id pub-id-type="pmid">15440996</pub-id>
</element-citation>
</ref>
<ref id="ref30">
<label>30</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Forster</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Browning</surname>
<given-names>AJ</given-names>
</name>
<name>
<surname>Paul</surname>
<given-names>AB</given-names>
</name>
<name>
<surname>Biyani</surname>
<given-names>CS</given-names>
</name>
</person-group>
<article-title>Surgical simulators in urological training--views of UK Training Programme Directors</article-title>
<source>BJU Int</source>
<year>2012</year>
<volume>110</volume>
<fpage>776</fpage>
<lpage>8</lpage>
<pub-id pub-id-type="pmid">22233327</pub-id>
</element-citation>
</ref>
<ref id="ref31">
<label>31</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Le</surname>
<given-names>CQ</given-names>
</name>
<name>
<surname>Lightner</surname>
<given-names>DJ</given-names>
</name>
<name>
<surname>VanderLei</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Segura</surname>
<given-names>JW</given-names>
</name>
<name>
<surname>Gettman</surname>
<given-names>MT</given-names>
</name>
</person-group>
<article-title>The current role of medical simulation in american urological residency training programs: An assessment by program directors</article-title>
<source>J Urol</source>
<year>2007</year>
<volume>177</volume>
<fpage>288</fpage>
<lpage>91</lpage>
<pub-id pub-id-type="pmid">17162066</pub-id>
</element-citation>
</ref>
<ref id="ref32">
<label>32</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hay</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Khan</surname>
<given-names>MS</given-names>
</name>
<name>
<surname>Van Poppel</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Van Cleynenbreugel</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Peabody</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Guru</surname>
<given-names>K</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Current Status and Effectiveness of Mentorship Programmes in Urology — A Systematic Review</article-title>
<source>BJU Int</source>
<comment>[In Press]</comment>
</element-citation>
</ref>
<ref id="ref33">
<label>33</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>McDougall</surname>
<given-names>EM</given-names>
</name>
<name>
<surname>Corica</surname>
<given-names>FA</given-names>
</name>
<name>
<surname>Chou</surname>
<given-names>DS</given-names>
</name>
<name>
<surname>Abdelshehid</surname>
<given-names>CS</given-names>
</name>
<name>
<surname>Uribe</surname>
<given-names>CA</given-names>
</name>
<name>
<surname>Stoliar</surname>
<given-names>G</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Short-term impact of a robot-assisted laparoscopic prostatectomy ‘mini-residency’ experience on postgraduate urologists’ practice patterns</article-title>
<source>Int J Med Robot</source>
<year>2006</year>
<volume>2</volume>
<fpage>70</fpage>
<lpage>4</lpage>
<pub-id pub-id-type="pmid">17520615</pub-id>
</element-citation>
</ref>
<ref id="ref34">
<label>34</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gamboa</surname>
<given-names>AJ</given-names>
</name>
<name>
<surname>Santos</surname>
<given-names>RT</given-names>
</name>
<name>
<surname>Sargent</surname>
<given-names>ER</given-names>
</name>
<name>
<surname>Louie</surname>
<given-names>MK</given-names>
</name>
<name>
<surname>Box</surname>
<given-names>GN</given-names>
</name>
<name>
<surname>Sohn</surname>
<given-names>KH</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Long-term impact of a robot assisted laparoscopic prostatectomy mini fellowship training program on postgraduate urological practice patterns</article-title>
<source>J Urol</source>
<year>2009</year>
<volume>181</volume>
<fpage>778</fpage>
<lpage>82</lpage>
<pub-id pub-id-type="pmid">19091351</pub-id>
</element-citation>
</ref>
<ref id="ref35">
<label>35</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Patel</surname>
<given-names>SR</given-names>
</name>
<name>
<surname>Hedican</surname>
<given-names>SP</given-names>
</name>
<name>
<surname>Bishoff</surname>
<given-names>JT</given-names>
</name>
<name>
<surname>Shichman</surname>
<given-names>SJ</given-names>
</name>
<name>
<surname>Link</surname>
<given-names>RE</given-names>
</name>
<name>
<surname>Wolf</surname>
<given-names>JS</given-names>
<suffix>Jr</suffix>
</name>
<etal></etal>
</person-group>
<article-title>Skill based mentored laparoscopy course participation leads to laparoscopic practice expansion and assists in transition to robotic surgery</article-title>
<source>J Urol</source>
<year>2011</year>
<volume>186</volume>
<fpage>1997</fpage>
<lpage>2000</lpage>
<pub-id pub-id-type="pmid">21944138</pub-id>
</element-citation>
</ref>
<ref id="ref36">
<label>36</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Herron</surname>
<given-names>DM</given-names>
</name>
<name>
<surname>Marohn</surname>
<given-names>M</given-names>
</name>
</person-group>
<collab>SAGES-MIRA Robotic Surgery Consensus Group</collab>
<article-title>A consensus document on robotic surgery</article-title>
<source>Surg Endos</source>
<year>2008</year>
<volume>22</volume>
<fpage>313</fpage>
<lpage>25</lpage>
</element-citation>
</ref>
<ref id="ref37">
<label>37</label>
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Goh</surname>
<given-names>AC</given-names>
</name>
<name>
<surname>Goldfarb</surname>
<given-names>DW</given-names>
</name>
<name>
<surname>Sander</surname>
<given-names>JC</given-names>
</name>
<name>
<surname>Miles</surname>
<given-names>BJ</given-names>
</name>
<name>
<surname>Dunkin</surname>
<given-names>BJ</given-names>
</name>
</person-group>
<article-title>Global evaluative assessment of robotic skills: Validation of a clinical assessment tool to measure robotic surgical skills</article-title>
<source>J Urol</source>
<year>2012</year>
<volume>187</volume>
<fpage>247</fpage>
<lpage>52</lpage>
<pub-id pub-id-type="pmid">22099993</pub-id>
</element-citation>
</ref>
</ref-list>
</back>
</pmc>
<affiliations>
<list>
<country>
<li>Inde</li>
<li>États-Unis</li>
</country>
<region>
<li>Massachusetts</li>
<li>Michigan</li>
</region>
</list>
<tree>
<country name="États-Unis">
<region name="Michigan">
<name sortKey="Sood, Akshay" sort="Sood, Akshay" uniqKey="Sood A" first="Akshay" last="Sood">Akshay Sood</name>
</region>
<name sortKey="Aggarwal, Shruti" sort="Aggarwal, Shruti" uniqKey="Aggarwal S" first="Shruti" last="Aggarwal">Shruti Aggarwal</name>
<name sortKey="Bhandari, Mahendra" sort="Bhandari, Mahendra" uniqKey="Bhandari M" first="Mahendra" last="Bhandari">Mahendra Bhandari</name>
<name sortKey="Campbell, Logan" sort="Campbell, Logan" uniqKey="Campbell L" first="Logan" last="Campbell">Logan Campbell</name>
<name sortKey="Jeong, Wooju" sort="Jeong, Wooju" uniqKey="Jeong W" first="Wooju" last="Jeong">Wooju Jeong</name>
<name sortKey="Menon, Mani" sort="Menon, Mani" uniqKey="Menon M" first="Mani" last="Menon">Mani Menon</name>
</country>
<country name="Inde">
<noRegion>
<name sortKey="Ahlawat, Rajesh" sort="Ahlawat, Rajesh" uniqKey="Ahlawat R" first="Rajesh" last="Ahlawat">Rajesh Ahlawat</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Ticri/CIDE/explor/HapticV1/Data/Ncbi/Merge
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 003625 | SxmlIndent | more

Ou

HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd -nk 003625 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Ticri/CIDE
   |area=    HapticV1
   |flux=    Ncbi
   |étape=   Merge
   |type=    RBID
   |clé=     PMC:4290108
   |texte=   Robotic surgical skill acquisition: What one needs to know?
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/RBID.i   -Sk "pubmed:25598593" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd   \
       | NlmPubMed2Wicri -a HapticV1 

Wicri

This area was generated with Dilib version V0.6.23.
Data generation: Mon Jun 13 01:09:46 2016. Site generation: Wed Mar 6 09:54:07 2024