title: Safe introduction of laparoscopic and retroperitoneoscopic nephrectomy in clinical practice: impact of a modular training program.
abstract: OBJECTIVE
  To describe and validate a novel modular training scheme (MTS) for trans-peritoneal laparoscopic nephrectomy (LN) and retroperitoneoscopic nephrectomy (RN).
  
  
  METHODS
  Four consultant urologists attended a Masterclass in "Advanced Laparoscopic and Robotic Surgery," certified by the University of Turin (IT). The Masterclass was based on a supervised MTS, which involved progressive, proficiency-based training through nine and seven steps for LN and RN, respectively. After becoming proficient in all the steps, each trainee performed a minimum of five procedures as first operator under direct observation of the mentor in the training centre. Then, each trainee independently performed 10 LN and 10 RN at his home institution. The surgical outcomes were compared with those from a contemporary series of procedures performed by the mentor.
  
  
  RESULTS
  All trainees successfully completed the 12-week MTS program. Median number of training cases to become competent in trans-peritoneal LN and RN was 13.0 (IQR 11.5-20.5) and 23.5 (IQR 19.5-32.0), respectively. A significantly higher rate of conversion to open surgery was observed for RNs independently performed by the trainees in their hospital compared to the mentor (p = 0.033). Failure to progress due to difficult anatomical orientation and abdominal wall bleeding during dissection of retroperitoneal space were the most frequent reasons of conversion.
  
  
  CONCLUSIONS
  A 12-week intensive modular program allows to achieve proficiency in performing independently LN and a RN after a median of 13 and 23.5 cases, respectively. Therefore, these procedures can be safely introduced and implemented in clinical practice within a relatively short time.
authors.affiliation: Department of Urology, Magna Graecia University, Viale Europa, Germaneto, 88100, Catanzaro, Italy. cantiello@unicz.it.|Masterclass in "Advanced Laparoscopic and Robotic Surgery", San Luigi Gonzaga Hospital, University of Turin, Orbassano Turin, Italy. cantiello@unicz.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cantiello
authors.affiliation: Department of Urology and Kidney Transplantation, Riuniti Hospital, Reggio Calabria, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Veneziano
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Department of Urology, Magna Graecia University, Viale Europa, Germaneto, 88100, Catanzaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Urology Institute, University Hospitals, Cleveland, OH, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Department of Urology, Magna Graecia University, Viale Europa, Germaneto, 88100, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.|Masterclass in "Advanced Laparoscopic and Robotic Surgery", San Luigi Gonzaga Hospital, University of Turin, Orbassano Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
mesh_terms: D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007558:Italy; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D000071252:Mentoring; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000193:education* / Q000379:methods; D012187:Retroperitoneal Space / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000193:education; D014572:Urology / Q000193:education*
keywords: Laparoscopic nephrectomy; Mentoring; Modular training