The ERUS Curriculum for Robot-assisted Partial Nephrectomy: Structure Definition and Pilot Clinical Validation

Alessandro Larcher, Geert De Naeyer, Filippo Turri, Paolo Dell'Oglio, Umberto Capitanio, Justin W. Collins, Peter Wiklund, Henk Van Der Poel, Francesco Montorsi, Alexandre Mottrie

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Background: No validated training program for robot-assisted partial nephrectomy (RAPN) exists. Objective: To define the structure and provide a pilot clinical validation of a curriculum for robot-assisted partial nephrectomy (RAPN). Design, setting, and participants: A modified Delphi consensus methodology involving 27 experts defined curriculum structure. One trainee completed the curriculum under the mentorship of an expert. A total of 40 patients treated with curriculum RAPN (cRAPN) were compared with 160 patients treated with standard of care (sRAPN). Outcome measurements and statistical analysis: To define curriculum structure, consensus was defined as ≥90% expert agreement. To investigate curriculum safety, perioperative morbidity, renal function, and pathologic outcomes were evaluated. To investigate curriculum efficacy, RAPN steps and modules attempted and completed by the trainee were evaluated. Propensity score matching identified comparable cRAPN and sRAPN cases. Mann–Whitney U test, chi-square test, and linear regression were used to investigate the impact of the curriculum on patient's outcome and the impact of trainee's experience on surgical independence. Results and limitations: Consensus-based key statements defined curriculum structure. No difference was recorded between cRAPN and sRAPN with respect to intraoperative or overall and grade-specific postoperative complications, blood loss, ischemia time, postoperative estimated glomerular filtration rate, and positive surgical margins (all p > 0.05). Conversely, operative time was longer after cRAPN (p < 0.0001). The trainee completed all phases of the curriculum and the trainee's experience was associated with more steps attempted/completed and increasing complexity of module attempted/completed (all p < 0.0001). The limitations of the study are the enrolment of a single trainee at a single institution and the small sample size. Accordingly, the large confidence intervals observed cannot exclude inferior outcomes in case of cRAPN and further study is required to confirm safety. Conclusions: The European Association of Urology (EAU) Robotic Urology Section (ERUS) curriculum for RAPN can protect patients from suboptimal outcome during the learning curve of the surgeon and can aid surgeons willing to start an RAPN program. Patient summary: Patients should be aware that structured training programs can reduce the risk of suboptimal outcome due to the learning curve of the surgeon. The European Association of Urology (EAU) Robotic Urology Section curriculum for robot-assisted partial nephrectomy can protect patients from suboptimal outcome during the learning curve and can aid surgeons willing to start a robot-assisted partial nephrectomy (RAPN) program. The curriculum is safe, because it does not result in any detriment to patient's clinical outcomes and is effective, as allows the transition from the beginning of surgical experience through increasing responsibility to the independent completion of a full case.

Original languageEnglish
Pages (from-to)1023-1031
Number of pages9
JournalEuropean Urology
Volume75
Issue number6
DOIs
StatePublished - Jun 2019

Keywords

  • Curriculum
  • Learning curve
  • Nephron-sparing surgery
  • Partial nephrectomy
  • Robot-assisted surgery
  • Training

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