Surgical Training in the Robotic Surgery Era: The Importance of Structured Programs

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Our generation is witnessing a technological evolution taking place in surgical practice in general and in the field of urology in particular. The introduction of robotic surgery has been an important advancement that is now widely accepted by patients as well by surgeons. The need of the hour is for optimally trained urologists who can effectively operate on the robotic platform. In this issue of the European Urology Focus, Lovegrove et al. addressed the very pertinent issue of training and assessment in robotic surgery [1]. They evaluated the validity, impact, effectiveness, and acceptability of various training modules available for robotic surgery. As with any new skill acquisition, robotic surgery has a learning curve that every surgeon will go through during the training period before becoming proficient in the technique. Several reports have demonstrated that increased experience and higher surgical volumes are associated with more favorable outcomes, such us lower postoperative complications, shorter operation time, minimal blood loss, lower readmission rates, lower costs, and better cancer control [2,3]. Another way in which this can be interpreted is that less experienced surgeons with lower surgical volumes have suboptimal outcomes. Mentoring new surgeons during the early phase of their learning curve is of the utmost importance to ensure patient safety, which is the most important factor and eventually determines the medicolegal sustainability of the technique. Traditionally, the method of training has been a mentored surgical apprenticeship; however, the system of presuming that skill acquisition is based on time spent under apprenticeship and subjective evaluation of skill acquisition has been challenged [4]. The contemporary