First definition and clinical validation of a training curriculum for RAPN
By Loek Keizer
The 2020 EAU Hans Marberger Award was awarded to Dr. Alessandro Larcher of Milan (IT). His paper “The ERUS Curriculum for Robot-assisted Partial Nephrectomy: Structure Definition and Pilot Clinical Validation” was published in Issue 6, Vol. 75 of European Urology and was deemed the best European paper published on minimally-invasive surgery in urology.
The award, annually given since 2004, is named after Prof. Hans Marberger to honour his pioneering achievements and contributions to endourology and the development of urologic minimally invasive surgical procedures. Previous winners include Profs. Morgan Roupret (2011) and Jens Rassweiler (2013) and most recently Dr. Larcher’s compatriot Dr. Giuseppe Simone (2019). The award is supported by a grant of €5,000 from KARL STORZ SE & CO.KG.
Dr. Larcher is a staff urologist at San Raffaele Hospital in Milan, having previously completed fellowships in Montreal (CA) and Aalst (BE). He is currently also Scientific Director at ORSI Academy in Melle, Belgium. Larcher has been involved with the EAU in several guises: his the Chair of the Junior ERUS/YAU working group on robot-assisted surgery and the Digital Media Associate Editor for European Urology.
Dr. Larcher’s paper, co-written with many prominent robotic urologists, outlines and measures the efficacy of the recently established training curriculum for robot-assisted partial nephrectomy.
From the paper: “In urology, patients treated during the learning phase of the surgeon are at risk of inferior outcomes relative to those treated when adequate experience is accumulated in case of open, laparoscopic, or robot-assisted radical prostatectomy (RARP). To counter such suboptimal outcomes observed during the learning curve of radical prostatectomy, specific training programmes have been proposed and the European Association of Urology (EAU) Robotic Urology Section (ERUS) developed a curriculum based on theoretical knowledge, preclinical simulation, and interaction between mentor and trainee, allowing for the proficiency-based progression across modules with growing complexity.”
“Although robot-assisted partial nephrectomy (RAPN) is another complex urological procedure with a non-negligible learning curve, no validated training programme is currently available for this procedure. To address this void, this study aims to define the structure of a curriculum for RAPN and to provide its pilot clinical validation, with the ultimate goal of improving patient’s outcome during the learning curve of the surgeon.”
“This study is the first definition and clinical validation of a training curriculum for RAPN. The ERUS curriculum for RAPN can protect patients from suboptimal outcome during the learning curve of the surgeons and can aid surgeons willing to start a RAPN programme. In the pilot phase of clinical validation, no evidence of any detriment with respect to patient’s clinical outcomes was recorded and the programme allowed for the transition from the beginning of surgical experience through increasing responsibility to the independent completion of a full case. To ensure generalizability, the observed safety profile must be confirmed in a larger cohort of patients and the observed efficacy profile must be confirmed in a larger cohort of trainees in a multi-institutional setting.”
Dr. Larcher spoke to European Urology Today on the occasion of his being awarded the Hans Marberger Award.
Congratulations on winning the award. Your paper both defined and assessed a curriculum for RAPN. Could you explain why this was a necessity?
“Human factors such as experience and training are key determinants of patient’s outcome after surgery. Structured training programmes allow for better results in shorter time.”
Its conclusions indicated that the curriculum is a success. How have these conclusions changed training for RAPN?
“The aim of the ERUS is to develop structured training programmes for robot-assisted surgery that can be taken as paradigm. The RAPN curriculum is a crucial piece of the larger puzzle.”
What’s next in the field of robotic training?
“ERUS will be expanding the curriculum with a training model for any renal surgery procedure such as pieloplasty, radical nephrectomy or nephroureterectomy.”
Why do you think your paper was chosen for the award?
“The study design was innovative and unique. It is the first investigation in surgery studying the impact of a surgical training on patients’ outcome and taking into consideration patient’s outcomes.”
How do you feel about your name being listed among the other award winners?
“It’s such a privilege. It is a great honour to find my name among the giants of laparoscopy that have won the award since 2004.”