Training and learning robotic surgery, time for a more structured approach: a systematic review HWR Schreuder, a R Wolswijk, a RP Zweemer, a MP Schijven, b RHM Verheijen a a Division of Women and Baby, Department of Gynaecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands b Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands Correspondence: HWR Schreuder, Department of Gynaecological Oncology, University Medical Centre Utrecht, PO Box 85500, room F05-126, 3508 GA, Utrecht, the Netherlands. Email: h.w.r.schreuder@umcutrecht.nl Accepted 26 July 2011. Published Online 7 October 2011. Background Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. Objectives To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. Search strategy A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed. Selection criteria We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism. Data collection and analysis Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation. Main results We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme. Authors’ conclusions Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes. Keywords Curriculum, education, learning, robotic surgery, training. Please cite this paper as: Schreuder H, Wolswijk R, Zweemer R, Schijven M, Verheijen R. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 2012;119:137–149. Introduction The introduction of robot assisted laparoscopic surgery has revolutionised the field of minimal invasive surgery and is growing rapidly in various fields of surgery. 1–3 The rapid introduction of robotic procedures necessitates new training methods. Next to the more traditional forms of surgical teaching, the robotic system seems ideal for integrating various forms of simulation. 4 While using simulation, surgeons can develop their skills and pass their basic learning curve on a simulator, hence avoiding the medico-legal aspects of surgical training. 5 Implement- ing simulation has the potential to create high-quality, competence-based robotic training programmes. This could shorten the learning curve and thereby ensure patient safety and surgical outcome. 6 Next, simulation allows experienced surgeons to develop or familiarise themselves with new instruments in a virtual environ- ment. 7 Recently, the Dutch Health Care Inspectorate (IGZ) has published its report Insufficiently prepared introduction of robotic surgery. 8 With regard to training, it is stated that ‘in 50% of the hospitals were insufficient criteria for the sur- geon’s competence before starting with robotic surgery’. This is indicative for the growing need for competence- based training and assessment criteria. In 2007, an inter- national multidisciplinary consensus group published a consensus statement on robotic surgery. Training and ª 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2011 RCOG 137 DOI: 10.1111/j.1471-0528.2011.03139.x www.bjog.org Systematic review