Training of Brazilian Urology residents in laparoscopy: results of a national survey

Over the last two decades we have seen the development of the minimally invasive surgery (MIS) on the Urology field and laparoscopy was the main part of it, considered as a great option for many of the urological conditions. The laparoscopic procedures, as in other specialties, became popular by reducing morbidity, convalescence period and showed good results at the literature, becoming attractive for most of urologists. On this paper, the authors evaluate the access of Brazilian urology residents to laparoscopy surgery, methods of training and perspectives (1). The Brazilian paper showed a nice response rate (85% of residents) and most of the medical doctors were from the academic hospitals. The most common laparoscopic procedure was radical nephrectomy (73.2%), but less than one third (28.8%) of residents acted as surgeons. On other nice study about the same issue, surgeons from Portugal compared themselves training with the rest of Europe, showing that all of them had good access to laparoscopic procedures, mostly as assistant (2). Among the Europeans, the most commonly performed procedure was total nephrectomy also. Most residents rate their motivation to perform laparoscopy in the future as "High" or "Very High", and plan performing a post-residency fellowship in this field. On Brazil, 61% of residents did not participate in hands-on courses or fellowship in laparoscopy and almost 30% of them affirms that they are prepared for professional life regarding urologic laparoscopy. A number that is suboptimal for the urology market after the learning period. Van der Poel et al. (3) also studied the training in minimally invasive surgery at the European Association of Urology. As the Brazilian authors, they showed that the training in MIS has shifted from 'see-one-do-one-teach-one' to a structured learning, from e-learning to skills laboratory and modular training settings (4). The authors concluded that Brazilian urologic residents have access to laparoscopy and actively participate in the learning process and that this should be encouraged. There is new scenario at the surgery specialties. Robotic surgery has became the new revolution in modern surgery, combining all the benefits of minimally invasive surgery with the advantage of three dimensions (3D) and better intracorporeal instrumentation. It is rapidly expanding in South America, mainly in Brazil, although still very far from most of the hospitals. The Urology staff must be prepared to teach our future residents at this new technology.

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Can remote assistance for robotic surgery improve surgical performance in simulation training? A prospective clinical trial of urology residents using a simulator in south america

Carneiro

Claros

Doyun

et al. 2022

Int. braz j urol.

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Introduction:We aimed to evaluate the role of remote proctoring during the initial training phases of a robotics curriculum using surgical robot skills simulator exercises. Materials and Methods: Prospective randomized study comprising 36 urology residents and junior staff urologists without previous robotic training. Group 1 (G1) performed exercises without any assistance or support, group 2 (G2) received support from in-person proctor, and group 3 (G3) from a remote proctor through a telementoring system. Qualitative and quantitative analyses were conducted for each exercise and group. Results: The overall score approval rates (OSA) for the different skill exercises were Ring Walk 2 (RW2) 83%, Energy Dissection 2 (ED2) 81%, and Ring Walk 3 (RW3) 14%. RW2 OSA was higher on attempt 3 than on attempt 1 (83.3% vs. 63.9%, p=0.032). ED2 OSA rate was higher in attempt 3 than in attempt 1 (80.6% vs. 52.8%, p=0.002). RW2 OSA was similar among the groups. In ED2, both remote and live assistance were significantly related to upper OSA (G1=47.2%, G2=75.0%, G3=83.3%, p=0.002). RW3 had similar OSA among the groups, which can be explained by the high level of difficulty and low OSA in all the groups. However, in a sensitive quantitative analysis, the mean overall score of the participants in RW3 was higher in both proctored groups (G1=24, G2=57.5, G3=51.5, p=0.042). Conclusion: Robotic performance increased significantly over three attempts for simulation exercises of low, medium, but not high-complexity. Proctoring, either in-person or remotely, has a positive impact on approval performance, particularly in intermediate tasks.

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Training of Brazilian Urology residents in laparoscopy: results of a national survey

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Can remote assistance for robotic surgery improve surgical performance in simulation training? A prospective clinical trial of urology residents using a simulator in south america

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