European urology open science · 2026
10-yr Outcomes of Senior Clinical Fellowship in Robot-assisted Radical Cystectomy (RARC) with focus on Intracorporeal Ileal Conduit Urinary Diversion: Aggregated Learning Curve Assessment and Achievement of the EAU-Robotic Urology Section (ERUS) RARC Curriculum.
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Del Giudice Francesco, Santarelli Valerio, Spurna Katarina, Kirmani Syed Ghazi Ali, Bhatti Noor Ul Huda, Gad Mohamed, Asero Vincenzo, Chung Benjamin I, Crocetto Felice, Challacombe Benjamin, Abu-Ghanem Yasmin, Mensah Elsie, Ibrahim Youssef, Chatterton Kathryn, Amery Suzanne, Alao Romerr, O'Kelly John, Parsons Brian Andrew, Tan Teck Wei, Moran Diarmaid, Doerge Unger Ella, Rai Sonpreet, Furrer Marc Alain, Kam Jonathan Sean, Nair Rajesh, Sahai Arun, Dasgupta Prokar, Thurairaja Ramesh, Khan Muhammad Shamim
Аннотация
OBJECTIVE: (1) To examine 10-yr outcomes of Robot-assisted Radical Cystectomy (RARC) with Intracorporeal Ileal Conduit (ICIC) performed by international clinical fellows within a 1-yr RCS-Eng Urothelial Senior Fellowship Programme. (2) To explore fellows' learning curve (LC) trajectories and perceived European Association of Urology Robotic Urology Section (ERUS) RARC/ICIC curriculum competency achievement.
METHODS: RARC/ICIC with curative intent for bladder cancer performed by supervised fellows (2015-2025) were reviewed. Perioperative outcomes and Kaplan-Meier survival trajectories served as surrogates of training competency and safety. Cumulative sum (CUSUM) model by operative time (OT) was applied for RARC/ICIC LC. Time to perceived proficiency across the 12 ERUS RARC/ICIC clinical modules was explored.
RESULTS: A total of 423 procedures (median follow-up 39 mo, interquartile range 16-70) were included. Proficiency by CUSUM was identified at 30th case, with significant reduction in total OT thereafter (350 vs 300 min, p = 0.017). Outcomes within learning and proficiency phases were comparable, including postoperative complications (36.6% vs 46.0%, p = 0.07), readmissions (16.9% vs 18.7%, p = 0.68), and cancer-specific survival (p = 0.97). ERUS curriculum acquisition was progressive: early modules in 0-1 mo by 88.9% of fellows and advanced modules in 4-6 mo by 100%. Skin-to-skin RARC/ICIC was achieved within ≤3, 4-6, and >6 mo in 11.1%, 33.3% and 55.6% of fellows, respectively. Previous robotic exposure was the only predictor for shorter time to independence (odds ratio, 2.34; 95% confidence interval 1.17-13.29). Post-fellowship, 88.9% of fellows continued independent RARC/ICIC practice.
CONCLUSIONS: Structured Senior Robotic Fellowship training achieves safe and efficient acquisition of RARC/ICIC skills. The observed LC corroborates the educational value of the ERUS modular curriculum in the setting of a tertiary referral center.
METHODS: RARC/ICIC with curative intent for bladder cancer performed by supervised fellows (2015-2025) were reviewed. Perioperative outcomes and Kaplan-Meier survival trajectories served as surrogates of training competency and safety. Cumulative sum (CUSUM) model by operative time (OT) was applied for RARC/ICIC LC. Time to perceived proficiency across the 12 ERUS RARC/ICIC clinical modules was explored.
RESULTS: A total of 423 procedures (median follow-up 39 mo, interquartile range 16-70) were included. Proficiency by CUSUM was identified at 30th case, with significant reduction in total OT thereafter (350 vs 300 min, p = 0.017). Outcomes within learning and proficiency phases were comparable, including postoperative complications (36.6% vs 46.0%, p = 0.07), readmissions (16.9% vs 18.7%, p = 0.68), and cancer-specific survival (p = 0.97). ERUS curriculum acquisition was progressive: early modules in 0-1 mo by 88.9% of fellows and advanced modules in 4-6 mo by 100%. Skin-to-skin RARC/ICIC was achieved within ≤3, 4-6, and >6 mo in 11.1%, 33.3% and 55.6% of fellows, respectively. Previous robotic exposure was the only predictor for shorter time to independence (odds ratio, 2.34; 95% confidence interval 1.17-13.29). Post-fellowship, 88.9% of fellows continued independent RARC/ICIC practice.
CONCLUSIONS: Structured Senior Robotic Fellowship training achieves safe and efficient acquisition of RARC/ICIC skills. The observed LC corroborates the educational value of the ERUS modular curriculum in the setting of a tertiary referral center.