Mr N VasdevPost CCT Robotic Urology Fellow

(Royal College of Surgeons of England / BAUS National Accredited Fellowship Programme) Lister Hospital

Stevenage

Faculty in Robotic UrologyChitra Sethia Robotic Centre

UCLHLondon

ROBOTIC FELLOWSHIP TRAINING IN THE UK

INTRODUCTION

• The widespread adoption of robotic technology over the past decade has resulted in significant changes in the way numerous urological conditions are managed

• Robotic devices continue to evolve and as they become less expensive and more widely disseminated – it is likely they will become more frequently utilized in an increasing number of surgical procedures

• The rapid introduction of robotic procedures in urology necessitates the need for the development of new training methods

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DA VINCI® EUROPEAN INSTALLED SYSTEMS 1999 – 2012

2004200520062007200820092010-12

WHAT’S CHANGED IN THE LAST DECADE?

Healthcare Cost and Utilization Project, Nationwide Inpatient Sample 2000–2008. NEJM,, 2010

ANNUAL NUMBER OF RADICAL PROSTATECTOMIES CARRIED OUT IN ENGLAND , 1997- 2010 (SOURCE: HES DATA)

TRAINING METHODS IN ROBOTIC UROLOGICAL TRAINING

• Robotic Simulation Training

• Simulation and Teaching enhanced learning initiative (STeLi) – Prof Dasgupta/ Mr S Khan

• Robotic Fellowship Training

• Structured Training programme that is competence/ assessment based

• There is no validated or standardized curriculum currently in existence for training in basic robotic surgical skills at present within the UK

• In a worldwide survey of both practising and trainee urologists, 78% of respondents felt it was required or beneficial to have training in RS 2

2. Guru KA et al, Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 2009;16:4736–41

ROBOTIC FELLOWSHIP TRAINING IN THE UK• There are currently 32 robotic systems installed in UK and Ireland, but the

geographical and population density localization is uneven. Most are located in London and the South East

• Only 6 (18.7%) of these centers offer robotic fellowship training currently [Only 1 fellowship Programme is currently recognized by the RCS/BAUS]

• Increased demand has led many practicing urologists to seek robotic training

• Furthermore, as robotic programs are newly introduced into urologic teaching centers, current SpR’s often do not get adequate robotic training while many in the faculty including robotic fellows are still overcoming their own learning curves

WHO APPLY KEEN TO APPLY FOR ROBOTIC FELLOWSHIP TRAINING IN THE UK

UKRobotic

Fellowship Training

UK Trainees

Visiting FellowsOverseas Trainees

(Europe / Australia)

ROBOTIC FELLOWSHIP TRAINING IN THE UK• There are 3 essential components to a robotic structured teaching program

• Maximizing the quality of robotic surgical training and minimizing adverse patient outcomes is best achieved through a structured mentoring/ fellowship programme

Robotic Fellowship

Training

Preclinical Phase

Table side assistant

phaseOperative console phase

ROBOTIC FELLOWSHIP TRAINING IN UK• In a robotic fellowship care must be provided in the context of a close-knit

surgical team

• There is no substitute for a regulated training fellowship programme. ‘Learning by doing’ is simply not good enough and puts the patient at risk 3

• Methodologies to improve robotic on-table surgical training include

• Dual Console training

• Strict audit

• Video feedback

• Debrief

3. Patel VR,, et al. Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol. 2005

CURRENT CENTERS OFFERING ROBOTIC FELLOWSHIPS IN THE UK• 1. Lister Hospital , Stevenage *

• 2. UCLH, London [Including the Chitra Sethia Robotic Training Centre]

• 3. Guys Hospital, London

• 4. Royal Marsden Hospital, London

• 5. Addenbrooke’s Hospital, Cambridge

• 6. Bristol Urological Institute

*RCS/BAUS national accredited fellowship programme 44. http://accreditation.rcseng.ac.uk/Home/InfoAccreditedFellowship

SUPPORT AVAILABLE FOR ROBOTIC FELLOWSHIP TRAINING IN THE UK• The Urology Foundation (TUF) funds a number of national and

international robotic preceptorships in collaboration with King's College London to support the safe training of individual surgeons and their teams

• Support from TUF is provided via clinical visits and Robotic Assisted Surgery Programme

• Intuitive Surgical Educational Grants

• Clinical Robotic Research Grants

• Technology Research Grants

• Clinical Robotic Fellowship

ROBOTIC FELLOWSHIP TRAINING – MY EXPERIENCE (LISTER ROBOTIC FELLOWSHIP)

• Completed my CCT in September 2012 (Northern Deanery)

• 110 hours of dry lab training

• 9 months into my fellowship

• 115 Robotic Cases

• Robotic Prostatectomy = 84 (15 independent cases)

• Robotic Partial Nephrectomy = 11

• Robotic Cystectomy = 9 (3 intracorporeal conduit + 2 neobladders)

• Robotic Nephrectomy = 4

• Robotic Pyeloplasty = 7 (3 independent cases)

ROBOTIC FELLOWSHIP TRAINING – MY EXPERIENCE (LISTER ROBOTIC FELLOWSHIP)

No effect on patient safety and oncological outcome with the introduction of the robotic fellowship programme

CONCLUSION• As the application of robotic surgery continues to expand in urologic surgery

in the UK, the need to train proficient robotic surgeons will also increases

• Robotic fellowship training exists in many current forms and is currently without standardization in the UK

• The most effective robotic training approach appears to be a structured fellowship training programme

• As technology continues to advance, surgical simulation is likely to play an essential role in the training of future robotic urologist to improve mastery of robotic surgical skills

ACKNOWLEDGEMENT• Mr James Adshead , Consultant Robotic Surgeon, Lister Hospital

• Mr Gregory Boustead, Consultant Robotic Surgeon, Lister Hospital

• Mr Tim Lane, Consultant Robotic Surgeon, Lister Hospital

• Dr Gowrie Mohan, Consultant Anesthetist, Lister Hospital

• Mrs June Thomas, Robotic Coordinator/ Sister Theatre, Lister Hospital

• Chitra Sethia Robotic Centre, UCLH