Skip to main content
SpringerLink
Log in

Laparoscopic and robotic surgical training in urology

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The most important change in urology during the past decade was the development of minimally invasive surgery, particularly laparoscopy. However, the main drawback of laparoscopy is a steep learning curve, which results from the significant changes in the surgical environment. Although laparoscopy can provide important advantages for the patient, including decreased length of hospitalization, decreased analgesic requirement, and a shortened postoperative convalescence, one concern has been whether laparoscopic techniques should be learned solely in the operating room. For example, sports, music, and aviation are practiced before an actual performance is ever undertaken. In this review, the advantages and limitations of all available training modalities in minimally invasive surgery are described. Testing basic laparoscopic skills on inanimate models, becoming familiar with the principles of dissection and hemostasis on living animals, and studying surgical anatomy on cadavers should be considered as indispensable and complementary elements for laparoscopic training in the future. In addition, telementoring with the help of modern image processing and virtual reality eventually may become the basis of tomorrow’s surgical instruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Guillonneau B, Abbou CC, Doublet JD, et al.: Proposal for a “European scoring system for laparoscopic operations in urology.” Eur Urol 2001, 40:2–6.

    Article  PubMed  CAS  Google Scholar 

  2. Guillonneau B, Rozet F, Cathelineau X, et al.: Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 2002, 167:51–56.

    Article  PubMed  Google Scholar 

  3. Gill IS, Zippe CD: Laparoscopic radical prostatectomy: technique. Urol Clin North Am 2001, 28:423–436.

    Article  PubMed  CAS  Google Scholar 

  4. Tevaearai HT, Mueller XM, von Segesser LK: 3-D vision improves performance in a pelvic trainer. Endoscopy 2000, 32:464–468.

    Article  PubMed  CAS  Google Scholar 

  5. Rassweiler J, Binder J, Frede T: Robotic and telesurgery: Will they change our future? Curr Opin Urol 2001, 11:309–320.

    Article  PubMed  CAS  Google Scholar 

  6. Summers AN, Rinehart GC, Simpson D, Redlich PN: Acquisition of surgical skills: a randomized trial of didactic, videotape, and computer-based training. Surgery 1999, 126:330–336.

    PubMed  CAS  Google Scholar 

  7. Medina M: Formidable challenges to teaching advanced laparoscopic skills. JSLS 2001, 5:153–158.

    PubMed  CAS  Google Scholar 

  8. Sreenivas VI, Pothula V: Videolaparoscopy in general surgery: an update. N C Med J 2001, 62:205–209.

    PubMed  CAS  Google Scholar 

  9. Melvin WS, Johnson JA, Ellison EC: Laparoscopic skills enhancement. Am J Surg 1996, 172:377–379.

    Article  PubMed  CAS  Google Scholar 

  10. Laguna MP, Hatzinger M, Rassweiler J: Simulators and endourological training. Curr Opin Urol 2002, 12:209–205.

    Article  PubMed  Google Scholar 

  11. Price DT, Chari RS, Neighbors JD Jr, et al.: Laparoscopic radical prostatectomy in the canine model. J Laparoendosc Surg 1996, 6:405–412.

    PubMed  CAS  Google Scholar 

  12. Giuffrida MC, Marquet RL, Kazemier G, et al.: Laparoscopic splenectomy and nephrectomy in a rat model: description of a new technique. Surg Endosc 1997, 11:491–494.

    Article  PubMed  CAS  Google Scholar 

  13. Lecuru F, Robin F, Neji K, et al.: Laparoscopic pelvic lymphadenectomy in an anatomical model: results of an experimental comparative trial. Eur J Obstet Gynecol Reprod Biol 1997, 72:51–55.

    Article  PubMed  CAS  Google Scholar 

  14. Chaudhry A, Sutton C, Wood J, et al.: Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human-computer interface. Ann R Coll Surg Engl 1999, 81:281–286.

    PubMed  CAS  Google Scholar 

  15. Haluck RS, Webster RW, Snyder AJ, et al.: A virtual reality surgical trainer for navigation in laparoscopic surgery. Stud Health Technol Inform 2001, 81:171–176.

    PubMed  CAS  Google Scholar 

  16. Voss G, Bockholt U, Los Arcos JL, et al.: LAHYSTOTRAIN intelligent training system for laparoscopy and hysteroscopy. Stud Health Technol Inform 2000, 70:359–364.

    PubMed  CAS  Google Scholar 

  17. Assimos DG, Vining DJ: Virtual endoscopy. J Endourol 2001, 15:47–51.

    Article  PubMed  CAS  Google Scholar 

  18. Torkington J, Smith SG, Rees BI, Darzi A: Skill transfer from virtual reality to a real laparoscopic task. Surg Endosc 2001, 15:1076–1079.

    Article  PubMed  CAS  Google Scholar 

  19. Yun MH, Cannon D, Freivalds A, Thomas G: An instrumented glove for grasp specification in virtual-reality-based pointand-direct telerobotics. IEEE Trans Syst Man Cybern B 1997, 27:835–846.

    Article  CAS  Google Scholar 

  20. Colegrove PM, Winfield HN, Donovan JF Jr, See WA: Laparoscopic practice patterns among North American urologists 5 years after formal training. J Urol 1999, 161:881–886.

    Article  PubMed  CAS  Google Scholar 

  21. Traxer O, Gettman MT, Napper CA, et al.: The impact of intense laparoscopic skills training on the operative performance of urology residents. J Urol 2001, 166:1658–1661. In a randomized study, the authors investigated the role of previous skills training on inanimate models on the improvement of performance during porcine laparoscopic nephrectomy. The authors concluded that in vivo training seems to be superior to skills training. However, the study population is small and skill training may have a more important impact on the performance of reconstructive surgery such as pyeloplasty or vesicourethral anastomosis.

    Article  PubMed  CAS  Google Scholar 

  22. Cadeddu JA, Wolfe JS Jr, Nakada S, et al.: Complications of laparoscopic procedures after concentrated training in urological laparoscopy. J Urol 2001, 166:2109–2111. The authors nicely demonstrate the favorable effects of a 12-month dedicated training program on surgical efficiency, learning curve, and complication rate.

    Article  PubMed  CAS  Google Scholar 

  23. Shalhav AL, Dabagia MD, Wagner TT, et al.: Training postgraduate urologists in laparoscopic surgery: the current challenge. J Urol 2002, 167:2135–2137. The authors describe their small fellowship model that enables postgraduate urologists to efficiently implement laparoscopic techniques into their daily practice.

    Article  PubMed  Google Scholar 

  24. Rosser JC Jr, Rosser LE, Savalgi RS: Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. Arch Surg 1998, 133:657–661.

    Article  PubMed  Google Scholar 

  25. Scott DJ, Bergen PC, Rege RV, et al.: Laparoscopic training on bench models: better and more cost-effective than operating room experience? J Am Coll Surg 2000, 191:272–278.

    Article  PubMed  CAS  Google Scholar 

  26. Hawasli A, Featherstone R, Lloyd L, Vorhees M: Laparoscopic training in residency program. J Laparoendosc Surg 1996, 6:171–174.

    PubMed  CAS  Google Scholar 

  27. Derossis AM, Bothwell J, Sigman HH, Fried GM: The effect of practice on performance in a laparoscopic simulator. Surg Endosc 1998, 12:1117–1120.

    Article  PubMed  CAS  Google Scholar 

  28. Fried GM, Derossis AM, Bothwell J, Sigman HH: Comparison of laparoscopic performance in vivo with performance measured in a laparoscopic simulator. Surg Endosc 1999, 13:1077–1081.

    Article  PubMed  CAS  Google Scholar 

  29. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR: Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997, 50:854–857.

    Article  PubMed  CAS  Google Scholar 

  30. Hoznek A, Salomon L, Rabii R, et al.: Vesicourethral anastomosis during laparoscopic radical prostatectomy: the running suture method. J Endourol 2000, 14:749–753.

    Article  PubMed  CAS  Google Scholar 

  31. Gates EA: New surgical procedures: Can our patients benefit while we learn? Am J Obstet Gynecol 1997, 176:1293–1298.

    Article  PubMed  CAS  Google Scholar 

  32. Witzke DB, Hoskins JD, Mastrangelo MJ Jr, et al.: Immersive virtual reality used as a platform for perioperative training for surgical residents. Stud Health Technol Inform 2001, 81:577–583.

    PubMed  CAS  Google Scholar 

  33. Patterson P: Hazards of electrosurgery in laparoscopy overlooked. OR Manager 1993, 9:6–8.

    Google Scholar 

  34. See WA, Cooper CS, Fisher RJ: Predictors of laparoscopic complications after formal training in laparoscopic surgery. JAMA 1993, 270:2689–2692.

    Article  PubMed  CAS  Google Scholar 

  35. Tucker RD, Voyles CR: Laparoscopic electrosurgical complications and their prevention. AORN J 1995, 62:51–53.

    Article  PubMed  CAS  Google Scholar 

  36. Chung JY, Sackier JM: A method of objectively evaluating improvements in laparoscopic skills. Surg Endosc 1998, 12:1111–1116.

    Article  PubMed  CAS  Google Scholar 

  37. Munday D, Kerin J: A laparoscopic surgical training and accreditation program up and running. Aust N Z J Obstet Gynaecol 1999, 39:430–437.

    PubMed  CAS  Google Scholar 

  38. Kavoussi LR, Moore RG, Partin AW, et al.: Telerobotic-assisted laparoscopic surgery: initial laboratory and clinical experience. Urology 1994, 44:15–19.

    Article  PubMed  CAS  Google Scholar 

  39. Janetschek G, Bartsch G, Kavoussi LR: Transcontinental interactive laparoscopic telesurgery between the United States and Europe. J Urol 1998, 160:1413.

    Article  PubMed  CAS  Google Scholar 

  40. Schulam PG, Docimo SG, Saleh W, et al.: Telesurgical mentoring: initial clinical experience. Surg Endosc 1997, 11:1001–1005.

    Article  PubMed  CAS  Google Scholar 

  41. Sung GT, Gill IS, Hsu TH: Robotic-assisted laparoscopic pyeloplasty: a pilot study. Urology 1999, 53:1099–1103.

    Article  PubMed  CAS  Google Scholar 

  42. Guillonneau B, Jayet C, Tewari A, et al.: Robot-assisted laparoscopic nephrectomy. J Urol 2001, 166:200–201.

    Article  PubMed  CAS  Google Scholar 

  43. Guillonneau B, Cappele O, Martinez JB, et al.: Robotic-assisted, laparoscopic pelvic lymph node dissection in humans. J Urol 2001, 165:1078–1081.

    Article  PubMed  CAS  Google Scholar 

  44. Abbou CC, Hoznek A, Salomon L, et al.: Laparoscopic radical prostatectomy with a remote-controlled robot. J Urol 2001, 165:1964–1966.

    Article  PubMed  CAS  Google Scholar 

  45. Binder J, Kramer W: Robotically assisted laparoscopic radical prostatectomy. BJU Int 2001, 87:408–410.

    Article  PubMed  CAS  Google Scholar 

  46. Gettman MT, Neururer R, Bartsch G, Peschel R: Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology 2002, 60:509–513.

    Article  PubMed  Google Scholar 

  47. Hoznek A, Zaki SK, Samadi DB, et al.: Robotic-assisted kidney transplantation: an initial experience. J Urol 2002, 167:1604–1606.

    Article  PubMed  Google Scholar 

  48. Yohannes P, Rotariu P, Pinto P, et al.: Comparison of robotic versus laparoscopic skills: Is there a difference in the learning curve? Urology 2002, 60:39–45.

    Article  PubMed  Google Scholar 

  49. Menon M, Shrivastava A, Tewari A, et al.: Laparoscopic and robot-assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002, 168:945–949. This is a well-designed study demonstrating that a structured training program together with robotic technology significantly shortens the learning curve of laparoscopic radical prostatectomy.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’Urologie CHU Henri Mondor, 51 Av Du Ml De Lattre de Tassigny, 94010, Créteil, France

    András Hoznek MD

Authors
  1. András Hoznek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ran Katz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Gettman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laurent Salomon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Antiphon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandre de la Taille MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. René Yiou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dominique Chopin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Clément-Claude Abbou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoznek, A., Katz, R., Gettman, M. et al. Laparoscopic and robotic surgical training in urology. Curr Urol Rep 4, 130–137 (2003). https://doi.org/10.1007/s11934-003-0040-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-003-0040-0

Keywords

Search

Navigation