title: Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.
abstract: 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 hypothesized that the number of MIS procedures performed 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).
  
  
  METHODS
  The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (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 patients underwent major intricate MIS: 16 pyeloplasties, 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.
  
  
  CONCLUSIONS
  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, collaborating with other specialities, modular training and training outside the operating theatre.
  
  
  CONCLUSIONS
  Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands. Electronic address: rpjschroeder@hotmail.com.
authors.forename: R P J
authors.initials: RP
authors.lastname: Schroeder
authors.affiliation: University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: r.chrzan@amc.nl.
authors.forename: R J
authors.initials: RJ
authors.lastname: Chrzan
authors.affiliation: University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands. Electronic address: a.j.klijn@umcutrecht.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Klijn
authors.affiliation: University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: cf.kuijper@amc.nl.
authors.forename: C F
authors.initials: CF
authors.lastname: Kuijper
authors.affiliation: University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands. Electronic address: p.dik@umcutrecht.nl.
authors.forename: P
authors.initials: P
authors.lastname: Dik
authors.affiliation: University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands. Electronic address: t.p.v.m.deJong@umcutrecht.nl.
authors.forename: T P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D002648:Child; D004503:Education, Medical, Graduate / Q000379:methods*; D006776:Hospitals, Pediatric; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D010372:Pediatrics / Q000193:education; D019651:Plastic Surgery Procedures / Q000193:education*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014570:Urologic Diseases / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000193:education*; D014572:Urology / Q000193:education*
keywords: Hospital education department; Internship and residency; Laparoscopy; Minimally invasive surgical procedures; Pediatrics; Urology