Abdullah Erdem Canda Murat Keske

Robotik cerrahi, tüm dünyada çeşitli hastalıkların cerrahi tedavisinde giderek artan sıklıkta uygulanmaktadır. Lokalize prostat kanseri tedavisinde radikal prostatektomi uzun süreli kanser kontrolü sağlamaktadır. İlk kez 2001 yılında uygulanmaya başlaması ile birlikte robotik radikal prostatektomi (RARP), hem hastalar hem de ürologlar tarafından prostat kanserinde tercih edilen ameliyat yöntemi haline gelmiştir. Bu modern ameliyat yönteminin eğitimi de oldukça önemli bir konudur. Bu makale, RARP ameliyat yönteminin eğitimi ile ilgili uluslararası literatür incelenerek, internet üzerinden robotik prostat kanseri cerrahisi eğitimi araştırılarak ve bu konuda eğitim veren merkezlerin eğitim programları incelenerek hazırlanmıştır. Robotik prostat kanseri cerrahisi eğitimi ile ilgili şu basamaklar özetlenmiştir; I. Ameliyatlara ait video izlemeye dayalı eğitim, II. Robotik cerrahi ile ilgili kurslara, sempozyumlara ve toplantılara katılmak, III. Ameliyathanede robotik cerrahi ameliyatlarını izlemek, IV. Simülatörler üzerinde eğitim almak, V. Çeşitli eğitim materyalleri üzerinde cerrahi eğitim ile eğitim yapmak, VI. Anestezi altındaki çeşitli hayvan modelleri üzerinde laboratuvarda cerrahi robot ile eğitim yapmak, VII. Robotik cerrahi ameliyatlarında hasta başında asistanlık yapmak, VIII. Bu konuda deneyimli bir cerrahın gözetiminde konsol başında bire bir cerrahi eğitim almak, IX. Öğrenme eğirişi döneminde cerrahın kendi sonuçlarını değerlendirmesi ve X. Ankara Atatürk Hastanesi Robotik Radikal Prostatektomi Eğitim Modeli. Robotik prostat kanseri eğitiminde birçok yöntem kullanılabilmektedir. Bu yöntemlerin bir arada kullanılması ile etkili ve yeterli eğitim sağlanabilmektedir

Training Modalities in Robotic Prostate Cancer Surgery

Robotic surgery is increasingly being performed worldwide in the surgical treatments of various diseases. Radical prostatectomy provides long-term cancer control in patients with localized prostate cancer. Robotic radical prostatectomy (RARP) has increasingly become a preferred treatment of choice both by patients and urologists since its introduction in 2001. The training of this surgical approach is a very important subject. This paper was prepared following reviewing the published literature on training on RARP, an internet bases search related with robotic prostate cancer surgery training and reviewing the training programs of the centers who offer training in robotic urology. In the present paper, we summarized the training modalities in RARP including; I. Video based learning: watching edited and non-edited surgical videos, II. Attending courses, symposiums and meetings related with robotic surgery, III. Watching live robotic surgical cases in the operating room, IV. Training with simulators, V. Training with the surgical surgical robot on training materials, VI. Training with the surgical robot on live animals under anesthesia in the laboratory, VII. Patient site assisting during robotic surgical procedures, VIII. Performing robotic surgery as a console surgeon under the supervision of a experienced mentor (fellowship program), IX. Assessing outcomes of the robotic surgical procedures (learning curve) and X. Ankara Ataturk Hospital Robotic Radical Prostatectomy Training Model. Training in robotic prostate cancer surgery includes a variety of modalities. Effective and sufficient training could be obtained with the combination of the suggested training modalities.Keywords: Training modalities, robotic surgery, prostate cancer surgery.

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  • Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomic radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004;172:910-914.
  • Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 2007;110:1951-8.
  • Canda AE, Balbay MD. Robotic radical cystectomy for bladder cancer: Current perspectives. European Medical Journal Urology 2014;1:1014-110.
  • Canda AE, Atmaca AF, Akbulut Z, Asil E, Kilic M, Isgoren E, Balbay MD. Results of robotic radical prostatectomy in the hands of surgeons without previouslaparoscopic radical prostatectomy experience. Turkish Journal of Medical Sciences 2012;42(Suppl 1):1338-1346.
  • Canda AE, Atmaca AF, Altinova S, Akbulut Z, Balbay MD. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int. 2012 Aug;110(3):434-44.
  • Canda AE, Atmaca AF, Balbay MD. Robotic pyleloplasty: Step by step surgical technique. J Adv Robot Automat 2013;2:1-5.
  • Canda AE, Atmaca AF. Robotic zero ischemia partial nephrectomy: Step by step surgical technique with tips and tricks. Robotic surgery: Research and reviews 2014;1:1-9.
  • McDougall EM, Corica FA, Chou DS, Abdelshehid CS, Uribe CA, Stoliar G, Sala LG, Khonsari SS, Eichel L, Boker JR, Ahlering TE, Clayman RV. Short-term impact of a robot-assisted laparoscopic prostatectomy 'mini-residency' experience on postgraduate urologists' practice patterns. Int J Med Robot. 2006 Mar;2(1):70-4.
  • Patel VR. Essential elements to the establishment and design of a successful robotic surgery programme. Int J Med Robot. 2006 Mar;2(1):28-35.
  • Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002 Oct;236(4):458-63; discussion 463-4.
  • Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG. Proving the value of simulation in laparoscopic surgery. Ann Surg. 2004 Sep;240(3):518-25; discussion 525-8.
  • Laguna MP, Arce-Alcazar A, Mochtar CA, Van Velthoven R, Peltier A, de la Rosette JJ. Construct validity of the chicken model in the simulation of laparoscopic radical prostatectomy suture. J Endourol. 2006 Jan;20(1):69-73.
  • Judkins TN, Oleynikov D, Stergiou N. Objective evaluation of expert and novice performance during robotic surgical training tasks. Surg Endosc. 2009 Mar;23(3):590-7.
  • Sun LW, Van Meer F, Schmid J, Bailly Y, Thakre AA, Yeung CK. Advanced da Vinci Surgical System simulator for surgeon training and operation planning. Int J Med Robot. 2007 Sep;3(3):245-51.
  • Chitwood WR Jr, Nifong LW, Chapman WH, Felger JE, Bailey BM, Ballint T, Mendleson KG, Kim VB, Young JA, Albrecht RA. Robotic surgical training in an academic institution. Ann Surg. 2001 Oct;234(4):475-84; discussion 484-6.
  • Shim JH, Kim JG, Jeon HM, Park CH, Song KY. The robotic third arm as a competent analog of an assisting surgeon in radical gastrectomy: impact on short-term clinical outcomes. J Laparoendosc Adv Surg Tech A. 2013 May;23(5):447-51.
  • Mirheydar H, Jones M, Koeneman KS, Sweet RM. Robotic surgical education: a collaborative approach to training postgraduate urologists and endourology fellows. JSLS. 2009 Jul-Sep;13(3):287-92.
  • Rashid HH, Leung YY, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology. 2006 Jul;68(1):75-9.
  • Samadi D, Levinson A, Hakimi A, Shabsigh R, Benson MC. From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol. 2007 Mar;25(1):105-10.
  • Schroeck FR, de Sousa CA, Kalman RA, Kalia MS, Pierre SA, Haleblian GE, Sun L, Moul JW, Albala DM. Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate. Urology. 2008 Apr;71(4):597-601.
  • Guzzo TJ, Gonzalgo ML. Robotic surgical training of the urologic oncologist. Urol Oncol. 2009 Mar-Apr;27(2):214-7.
  • Jamshidi R, LaMasters T, Eisenberg D, Duh QY, Curet M. Video self-assessment augments development of videoscopic suturing skill. J Am Coll Surg. 2009 Nov;209(5):622-5.
  • Giedelman CA, Abdul-Muhsin H, Schatloff O, Palmer K, Lee L, Sanchez-Salas R, Cathelineau X, Dávila H, Cavelier L, Rueda M, Patel V. The impact of robotic surgery in urology. Actas Urol Esp. 2013 Nov-Dec;37(10):652-7.
  • Zorn KC, Orvieto MA, Gong EM, Mikhail AA, Gofrit ON, Zagaja GP, Shalhav AL. Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol. 2007 Apr;21(4):441-7.
  • Ou YC, Yang CR, Wang J, Cheng CL, Patel VR. Robotic-assisted laparoscopic radical prostatectomy: learning curve of first 100 cases. Int J Urol. 2010 Jul;17(7):635-40.
  • Canda AE, Balbay MD. Tasks of the assistant surgeon during robotic assisted radical prostatectomy (RARP).2nd Ankara Robotic Urology Symposium & Course Book, Canda AE (ed); (ISBN: 978-605-85925-0-6) 2013;24-27.
  • Canda AE, Akbulut Z, Atmaca AF, Altinova S, Balbay MD. Surgical Technique: Robotic-assisted laparoscopic radical prostatectomy (RARP).2nd Ankara Robotic Urology Symposium & Course Book, Canda AE (ed); (ISBN: 978-605-85925-0-6) 2013; 58-65.