Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons.
OBJECTIVE
With the exponential growth of robotic urological surgery, particularly with robot assisted radical prostatectomy, guidelines for safe initiation of this technology are a necessity. Currently no standardized credentialing system exists to our knowledge to evaluate surgeon competency and safety with robotic urological surgery performance. Although proctoring is a modality by which such competency can be evaluated, other training tools and guidelines are needed to ensure that the requisite knowledge and technical skills to perform this procedure have been acquired. We evaluated the current status of proctoring and credentialing in other surgical specialties to discuss and recommend its application and implementation specifically for robot assisted radical prostatectomy.


METHODS
We reviewed the literature on safety and medicolegal implications of proctoring and the safe introduction of surgical procedures to develop recommendations for robot assisted radical prostatectomy proctoring and credentialing.


RESULTS
Proctoring is an essential mechanism for robot assisted radical prostatectomy institutional credentialing and should be a prerequisite for granting unrestricted privileges on the robot. This should be differentiated from preceptoring, wherein the expert is directly involved in hands-on training. Advanced technology has opened new avenues for long-distance observation through teleproctoring. Although the medicolegal implications of an active surgical intervention by a proctor are not clearly defined, the role as an observer should grant immunity from malpractice liability.


CONCLUSIONS
The implementation of guidelines and proctoring recommendations is necessary to protect surgeons, proctors, institutions and, above all, the patients who are associated with the institutional introduction of a robot assisted radical prostatectomy program. With no current guidelines we anticipate this article will serve as a catalyst of interorganizational discussion to initiate regulatory oversight of surgeon certification and proctorship.
Zorn
Kevin C
KC
Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois 60637, USA. kzorn@surgery.bsd.uchciago.edu
Gautam
Gagan
G
Shalhav
Arieh L
AL
Clayman
Ralph V
RV
Ahlering
Thomas E
TE
Albala
David M
DM
Lee
David I
DI
Sundaram
Chandru P
CP
Matin
Surena F
SF
Castle
Erik P
EP
Winfield
Howard N
HN
Gettman
Matthew T
MT
Lee
Benjamin R
BR
Thomas
Raju
R
Patel
Vipul R
VR
Leveillee
Raymond J
RJ
Wong
Carson
C
Badlani
Gopal H
GH
Rha
Koon H
KH
Eggener
Scott E
SE
Wiklund
Peter
P
Mottrie
Alex
A
Atug
Fatih
F
Kural
Ali R
AR
Joseph
Jean V
JV
D002983:Clinical Competence; D003406:Credentialing / Q000592:standards*; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D012371:Robotics / Q000193:education* / Q000331:legislation & jurisprudence / Q000592:standards; D013520:Urologic Surgical Procedures / Q000193:education* / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards