Teaching advanced laparoscopic skills in urological surgery

Abstract

The first laparoscopic nephrectomy performed in 1990 heralded a new era in urological surgery. Since then there has been an exponential increase in the number of laparoscopic cases being performed each year with over 4000 laparoscopic nephrectomies performed in England in 2013. With increasing surgical experience the indications for minimally access approaches have also expanded to include even more complex procedures such as radical prostatectomy and cystectomy. Whilst this changing landscape brings significant patient benefits it is accompanied by very real challenges for surgical trainers. Recent changes to training mean that trainees must acquire these new and demanding technical skills during a shortened training programme. As a result we must carefully consider how surgeons learn new skills and incorporate these principles into laparoscopic training. A curriculum for learning advanced laparoscopy should include appropriate simulation, mentorship and assessment of competence.