Proficiency-based progression training for robotic surgery skills training: a randomized clinical trial

Ruben De Groote, Stefano Puliatti, Marco Amato, Elio Mazzone, Giuseppe Rossiello, Rui Farinha, Artur Paludo, Liesbeth Desender, Ben Van Cleynenbreugel, Brendan P. Bunting, Alexandre Mottrie, Anthony G. Gallagher, Alessandro Larcher, Pieter Uvin, Jasper Decoene, Tom Tuyten, Mathieu D’Hondt, Nicolas Hubert, Charles Chatzopoulos, Bart De Troyer

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Objective: To determine whether proficiency-based progression (PBP) training leads to better robotic surgical performance compared to traditional training (TT), given that the value of PBP training for learning robotic surgical skills is unclear. Materials and Methods: The PROVESA trial is a multicentric, prospective, randomized and blinded clinical study comparing PBP training with TT for robotic suturing and knot-tying anastomosis skills. A total of 36 robotic surgery-naïve junior residents were recruited from 16 training sites and 12 residency training programmes. Participants were randomly allocated to metric-based PBP training or the current standard of care TT, and compared at the end of training. The primary outcome was percentage of participants reaching the predefined proficiency benchmark. Secondary outcomes were the numbers of procedure steps and errors made. Results: Of the group that received TT, 3/18 reached the proficiency benchmark versus 12/18 of the PBP group (i.e. the PBP group were ~10 times as likely to demonstrate proficiency [P = 0.006]). The PBP group demonstrated a 51% reduction in number of performance errors from baseline to the final assessment (18.3 vs 8.9). The TT group demonstrated a marginal improvement (15.94 vs 15.44) in errors made. Conclusions: The PROVESA trial is the first prospective randomized controlled trial on basic skills training in robotic surgery. Implementation of a PBP training methodology resulted in superior surgical performance for robotic suturing and knot-tying anastomosis performance. Compared to TT, better surgical quality could be obtained by implementing PBP training for basic skills in robotic surgery.

Original languageEnglish
Pages (from-to)528-535
Number of pages8
JournalBJU International
Issue number4
Early online date25 May 2022
Publication statusPublished (in print/issue) - 31 Oct 2022

Bibliographical note

Funding Information:
This study was conducted on behalf of the Junior European Association of Urology (EAU) Robotic Urology Section (ERUS)/Young Academic Urologists working group on robot-assisted surgery of the EAU and the ERUS Education Working Group. ERUS Scientific Committee sponsorship of the seven Belgian surgeons is acknowledged. Alessandro Larcher (Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy), Pieter Uvin (Department of Urology, AZ Sint-Jan, Bruges, Belgium), Jasper Decoene (Department of Urology, OLV van Lourdes Hospital, Waregem, Belgium), Tom Tuyten (Department of Urology, Jessa Hospital, Hasselt, Belgium), Mathieu D'Hondt (Department of Surgery, AZ Groeninge, Kortrijk, Belgium), Nicolas Hubert (Department of Urology, CHR de la Citadelle, Liège, Belgium), Charles Chatzopoulos (Department of Urology, Chirec Hospital, Brussels, Belgium), Bart De Troyer (Department of Urology, AZ Nikolaas, Sint-Niklaas, Belgium).

Publisher Copyright:
© 2022 BJU International.


  • Urology
  • basic skills training
  • #Urology
  • surgical simulation
  • training
  • proficiency-based progression
  • robotic surgery


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