a Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands b University Children’s Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands c University Children’s Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands Correspondence to: R.P.J. Schroeder, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands, Tel.: þ31 205994810; fax: þ31 205993802 rpjschroeder@hotmail.com (R.P.J. Schroeder) r.chrzan@amc.nl (R.J. Chrzan) a.j.klijn@umcutrecht.nl (A.J. Klijn) cf.kuijper@amc.nl (C.F. Kuijper) p.dik@umcutrecht.nl (P. Dik) t.p.v.m.deJong@umcu- trecht.nl (T.P.V.M. de Jong) Keywords Internship and residency; Hos- pital education department; Laparoscopy; Minimally inva- sive surgical procedures; Pedi- atrics; Urology Received 16 October 2014 Accepted 14 March 2015 Available online xxx Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre R.P.J. Schroeder a , R.J. Chrzan b , A.J. Klijn c , C.F. Kuijper b , P. Dik c , T.P.V.M. de Jong c Summary Background Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hy- pothesized that the number of MIS procedures per- formed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. Objective To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). Study design The clinical activity of the department was retro- spectively reviewed by extracting the annual num- ber of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative pro- cedures (nephrectomy) and reconstructive pro- cedures (pyeloplasty) were analysed with reference to the patients’ ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Results Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 pa- tients underwent major intricate MIS: 16 pyelo- plasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children 2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. Discussion There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collab- orating with other specialities, modular training and training outside the operating theatre. Conclusion Even in a high-volume, paediatric urology educa- tional centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. + MODEL Please cite this article in press as: Schroeder RPJ, et al., Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre, Journal of Pediatric Urology (2015), http://dx.doi.org/10.1016/j.jpurol.2015.03.022 http://dx.doi.org/10.1016/j.jpurol.2015.03.022 1477-5131/ª 2015 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company. Journal of Pediatric Urology (2015) xx, 1.e1e1.e6