Training postgraduate urologists in laparoscopic surgery: The current challenge

Purpose: We established a new mini-fellowship training model for teaching laparoscopic urological surgery to practicing urologists that provides a learning experience beyond that of a pelvic trainer or hands-on, animal laboratory based laparoscopic course. It provides the practitioner with clinical experience under mentor direct guidance and supervision before embarking on independent laparoscopic surgery at an individual hospital. Materials and Methods: A mini-fellowship model was developed that consists of 3 phases, namely 1) completing a 2 to 3-day hands-on course in laparoscopy, including pelvic trainers and an animal model, 2) observing a clinical mentor perform 6 or more major renal laparoscopic cases and 3) performing 6 or more major renal procedures under mentor direct guidance in trainee patients at the mentor or trainee hospital after obtaining appropriate temporary privileges. Results: Two community urologists underwent the mini-fellowship program in 2000. Trainee 1 performed 30 laparoscopic procedures, including 17 radical nephrectomies, 4 simple nephrectomies, 4 nephroureterectomies, 4 renal cyst ablations and 1 renal biopsy, within the first 8 months after training and hospital accreditation. Trainee 2 performed 10 laparoscopic procedures within the first 3 months after training and hospital accreditation. Conclusions: This mini-fellowship model provides practicing urologists with a clinically applicable teaching experience to learn a new surgical concept using a familiar training pattern. It may be a more rapid and safe process of disseminating laparoscopic urological surgery to community urologists. Based on this model it would be possible for centers of excellence in each state to establish similar training programs for the corresponding urological community, thereby, bringing the teaching of new surgical skills to a more clinically relevant level.