European Basic Laparoscopic Urological Skills (E-BLUS): A feasibility study in a setting for robot-assisted surgery

Nikolaos Liakos^1*Martin W W Janssen²Rudolf Moritz³Özlem Kayaci-Güner⁴Johannes Bründl⁵Arif Özkan¹Burkhard Ubrig⁶Stefan Siemer⁷Christian Gratzke¹Dr Christian Wagner⁸

• ¹Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
• ²Department of Urology, Faculty of Medicine, Medical Centre of the University of Münster, Münster, Germany, Muenster, Germany
• ³Department of Urology, Marien Hospital, Herne, Germany, Herne, Germany
• ⁴European Robotic Institute Gronau, Gronau, Germany, Gronau, Germany
• ⁵Department of Urology, Caritas Hospital St.Josef, Regensburg, Germany, Regensburg, Bavaria, Germany
• ⁶Department ofUrology, Augusta Kranken-Anstalt Bochum, Bochum, Germany, Bochum, North Rhine-Westphalia, Germany
• ⁷Department of Urology and Paediatric Urology, Saarland University, Homburg, Germany, Homburg, Germany
• ⁸Department of Urology, Urological Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany, Gronau, Germany

Since the introduction of laparoscopy, a variety of training sets and tasks have been introduced for surgical education of minimally-invasive surgery. The implementation of the European Basic Laparoscopic Urological Skills into the training and education program of future laparoscopic surgeons created a new era and provided a standardized approach for urological surgical training. However, these tasks have not yet been evaluated in a setting of robot-assisted surgery. The aim of this study is to evaluate the feasibility of the implementation of the four E-BLUS tasks into training modules of robot-assisted surgery.A cohort of 31 robotic surgeons (group A: experienced, group B: novices) performed these tasks in two different institutions by using the latest generation of robotic surgical platforms. Time performance and failure rate were assessed and statistically analyzed.The groups demonstrated a statistically significant difference regarding time performance in half of the tasks involving fine surgical skills (cutting and knotting, p= 0.01 and p = 0.02, respectively) but no significant difference in tasks involving manual ambidexterity (p = 0.14 and 0.12, respectively). A low failure rate during the attempts of the group of novice robotic surgeons could be observed.The use of the E-BLUS tasks in a training setting of robot-assisted surgery is feasible and can lead to the development of surgical skills needed during robot-assisted surgical procedures. It is a relatively low-cost dry lab option for the introduction of novice robotic surgeons.