Bridging the knowledge gap in urology residency: Unperceived challenges in assisting robotic prostatectomy

Urology training programs internationally have adopted robotic surgery, particularly robotic prostatectomy. We aimed to determine the knowledge gap in the understanding of robotic prostatectomy for residents compared to urologists, as there is a need for dedicated robotic training curricula.

A 16-question survey was developed, documenting the difference in understanding between residents and urologists. The survey contained items pertaining to patient anatomy, procedural steps, and surgical decision-making. The survey was completed immediately following a robotic prostatectomy by both the urology resident performing the bedside assistance, and the urologist. Statistical analysis of the quantitative questions was performed using kappa scores, and thematic analysis was performed to analyze the qualitative responses.

Forty-two surveys were administered to urology residents and urologists at The Ottawa Hospital over 10 weeks. Disagreements were identified between urology resident and urologist responses. This was noted with the comparison of the following procedural steps: vesicourethral anastomosis (kappa 0.138), apical dissection (kappa 0.149), and seminal vesicle dissection (kappa 0.342). The qualitative responses found discrepancies between resident and urologist understanding. When asked to describe challenges during the procedure, urologists described causal factors leading to challenges and how to manage these issues intraoperatively. In contrast, the residents' responses focused on readily visible aspects of the procedure, including bleeding or difficult exposure, omitting to describe the cause of these challenges.

There is a gap in urology resident knowledge and understanding of a robotic prostatectomy. This information is key to expand the understanding of robotic prostatectomy surgical decision-making and its training.