Training and Education in Robotic Surgery: Recommendations of ERUS (EAU Robotic Urology Section)

  • Alexander Heinze
  • Paolo Umari
  • Nicola Fossati
  • Alexandre MottrieEmail author


The present chapter aims to give an overview of the importance of training in robotic surgery. It includes the past experiences in robotic urological surgery, the introduction of virtual reality simulation and more advanced training modalities as the wet lab and modular training.

This text will highlight the major problems encountered when developing a robotic program and the possible solutions to maximize the available resources of each center. It summarizes today’s available academic programs and assessment tools for knowledge and surgical skills acquisition.

Finally, it emphasizes on the necessity of a standardized program with defined educational objectives and the urge for an international standardized certification process. This chapter also explains the attractive robotic curriculum from the European Association of Urology Robotic Urology Section (ERUS). It is proposed as a well-structured program to be universally adopted in training centers providing a stepwise scheme able to endue experienced and unexperienced surgeons the opportunity to perform robotic surgery at the end of the course.


Robotic surgery Robotic curriculum Training Robot-assisted radical prostatectomy Education in robotics 


  1. 1.
    Leal Ghezzi T, Campos CO. 30 Years of robotic surgery. World J Surg. 2016;40(10):2550–7. Scholar
  2. 2.
    Diaz M, Peabody JO, Kapoor V, et al. Oncologic outcomes at 10 years following robotic radical prostatectomy. Eur Urol. 2015;67(6):1168–76. Scholar
  3. 3.
    Jackson MA, Bellas N, Siegrist T, et al. Experienced open vs. early robotic-assisted laparoscopic radical prostatectomy: a 10 year prospective/retrospective comparison. Urology. 2016;91:111–8. Scholar
  4. 4.
    Preece R. The current role of simulation in urological training. Cent Eur J Urol. 2015;68(2):207–11. Scholar
  5. 5.
    Sweet RM, Beach R, Sainfort F, et al. Introduction and validation of the American Urological Association Basic Laparoscopic Urologic Surgery Skills Curriculum. J Endourol. 2012;26(2):190–6. Scholar
  6. 6.
    Aydin A, Shafi AMA, Khan MS, Dasgupta P, Ahmed K. Current status of simulation and training models in urological surgery: a systematic review. J Urol. 2016;196(2):312–20. Scholar
  7. 7.
    Aggarwal R, Grantcharov T, Moorthy K, Hance J, Darzi A. A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. Am J Surg. 2006;191(1):128–33. Scholar
  8. 8.
    Menhadji A, Abdelshehid C, Osann K, et al. Tracking and assessment of technical skills acquisition among urology residents for open, laparoscopic, and robotic skills over 4 years: is there a trend? J Endourol. 2013;27(6):783–9. Scholar
  9. 9.
    Liberman D, Trinh Q-D, Jeldres C, Valiquette L, Zorn KC. Training and outcome monitoring in robotic urologic surgery. Nat Rev Urol. 2011;9(1):17–22. Scholar
  10. 10.
    Buchs NC, Pugin F, Volont F, Morel P. Learning tools and simulation in robotic surgery: state of the art. World J Surg. 2013;37(12):2812–9. Scholar
  11. 11.
    Brewin J, Ahmed K, Challacombe B. An update and review of simulation in urological training. Int J Surg. 2014;12(2):103–8. Scholar
  12. 12.
    Fisher RA, Dasgupta P, Mottrie A, et al. An over-view of robot assisted surgery curricula and the status of their validation. Int J Surg. 2015;13:115–23. Scholar
  13. 13.
    Ahmed K, Khan R, Mottrie A, et al. Development of a standardised training curriculum for robotic surgery: A consensus statement from an international multidisciplinary group of experts. BJU Int. 2015;116(1):93–101. Scholar
  14. 14.
    Dulan G, Rege RV, Hogg DC, et al. Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery. 2012;152(3):477–88. Scholar
  15. 15.
    Summers S, Anderson J, Petzel A, Tarr M, Kenton K. Development and testing of a robotic surgical training curriculum for novice surgeons. J Robot Surg. 2015;9(1):27–35. Scholar
  16. 16.
    Whittaker G, Aydin A, Raison N, et al. Validation of the robotiX mentor robotic surgery simulator. J Endourol. 2015;30(3):338–46. Scholar
  17. 17.
    Ahmed K, Amer T, Challacombe B, Jaye P. How to develop a simulation programme in urology. BJU Int. 2011;108:1698–702. Scholar
  18. 18.
    Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL. Development of a model for training and evaluation of laparoscopic skills. Am J Surg. 1998;175(6):482–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Smith R, Patel V, Satava R. Fundamentals of robotic surgery: a course of basic robotic surgery skills based upon a 14-society consensus template of outcomes measures and curriculum development. Int J Med Robot. 2014;10(3):379–84. Scholar
  20. 20.
    Stegemann AP, Ahmed K, Syed JR, et al. Fundamental skills of robotic surgery: a multi-institutional randomized controlled trial for validation of a simulation-based curriculum. Urology. 2013;81(4):767–74. Scholar
  21. 21.
    Foell K, Finelli A, Yasufuku K, et al. Robotic surgery basic skills training: evaluation of a pilot multidisciplinary simulation-based curriculum. Can Urol Assoc J. 7(11-12):430–4.
  22. 22.
    Aghazadeh MA, Mercado MA, Pan MM, Miles BJ, Goh AC. Performance of robotic simulated skills tasks is positively associated with clinical robotic surgical performance. BJU Int. 2016;118(3):475–81. Scholar
  23. 23.
    Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ. Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. J Urol. 2012;187(1):247–52. Scholar
  24. 24.
    Ritter EM, Scott DJ. Training curriculum for the fundamentals of laparoscopic surgery. Surg Innov. 2015;14:107–12.CrossRefGoogle Scholar
  25. 25.
    Goh AC, Aghazadeh MA, Mercado MA, et al. Multi-institutional validation of fundamental inanimate robotic skills tasks. J Urol. 2015;194(6):1751–6. Scholar
  26. 26.
    Zorn KC, Gautam G, Shalhav AL, et al. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol. 2009;182(3):1126–32. Scholar
  27. 27.
    Moustris GP, Hiridis SC, Deliparaschos KM, Konstantinidis KM. Evolution of autnomous and semi-autnomous robotic surgical systems: a review of the literature. Int J Med Robot. 2011;7:375–92. Scholar
  28. 28.
    Crossley J, Marriott J, Purdie H, Beard JD. Prospective observational study to evaluate NOTSS (non-technical skills for surgeons) for assessing trainees’ non-technical performance in the operating theatre. Br J Surg. 2011;98(7):1010–20. Scholar
  29. 29.
    Flin R, Yule S, Paterson-Brown S, Maran N, Rowley D, Youngson G. Teaching surgeons about non-technical skills. Surgeon. 2007;5(2):86–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Kumar R, Jog A, Vagvolgyi B, et al. Objective measures for longitudinal assessment of robotic surgery training. J Thorac Cardiovasc Surg. 2012;143(3):528–34. Scholar
  31. 31.
    Hung AJ, Bottyan T, Clifford TG, et al. Structured learning for robotic surgery utilizing a proficiency score: a pilot study. World J Urol. 2016;35:27–34. Scholar
  32. 32.
    Mirheydar H, Jones M, Koeneman KS, Sweet RM. Robotic surgical education: a collaborative approach to training postgraduate urologists and endourology fellows. JSLS. 2009;13:287–92.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Moreno Sierra J, Fernández Pérez C, Ortiz Oshiro E, Silmi Moyano A. Key areas in the learning curve for robotic urological surgery: a Spanish multicentre survey. Urol Int. 2011;87(1):64–9. Scholar
  34. 34.
    Cole AP, Leow JJ, Chang SL, et al. Surgeon and hospital level variation in the costs of robot-assisted radical prostatectomy. J Urol. 2016;196(4):1090–5. Scholar
  35. 35.
    Valvo JR, Madeb R, Gilbert R, et al. Policy guidelines suggested for robot-assisted prostatectomy. J Robot Surg. 2007;1(3):173–6. Scholar
  36. 36.
    Vetter MH, Green I, Martino M, Fowler J, Salani R. Incorporating resident/fellow training into a robotic surgery program. J Surg Oncol. 2015;112(7):684–9. Scholar
  37. 37.
    Lee JY, Mucksavage P, Sundaram CP, McDougall EM. Best practices for robotic surgery training and credentialing. J Urol. 2011;185(4):1191–7. Scholar
  38. 38.
    Volpe A, Ahmed K, Dasgupta P, et al. Pilot validation study of the European Association of Urology Robotic Training Curriculum. Eur Urol. 2015;68(2):292–9. Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Alexander Heinze
    • 1
    • 2
  • Paolo Umari
    • 1
    • 3
  • Nicola Fossati
    • 1
    • 4
  • Alexandre Mottrie
    • 1
    • 5
    • 6
    Email author
  1. 1.ORSI-AcademyMelleBelgium
  2. 2.Hospital Regional de Alta Especialidad de la Península de YucatánMéridaMexico
  3. 3.School of MedicineUniversidad Nacional Autónoma de MéxicoMexico CityMexico
  4. 4.Department of UrologyUniversity of Trieste, Ospedali riuniti di TriesteTriesteItaly
  5. 5.Division of Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
  6. 6.Department of UrologyOnze-Lieve-Vrouw HospitalAalstBelgium

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