Training in robotic urology (2): RMK AIMES offers HOT courses to Eurasia

With rapid developments in the area of robotic surgery and major changes to the landscape in recent years, the training of surgeons on robotic platforms is receiving more attention from the EAU and several other parties. The EAU has the mission to offer best possible care for urology patients, and offering the best possible training for surgeons is a part of that.

This is the second in a series of articles that explores the developments in robotic surgical training. You can read the first entry here.

By Prof. A. Erdem Canda
Koç University Hospital 
Department of Urology
Director, RMK AIMES Training & Conference Center
Istanbul 

The Rahmi M. Koç Academy of Interventional Medicine Education and Simulation (RMK AIMES) is a five-floor building with a 6500 m2 area. It is located in the same campus with Koç University Hospital in Istanbul that serves as the hub for hands-on training courses for all surgical and non-surgical specialties including urology, gynecology, general surgery, orthopedics, neurosurgery, otolaryngology, plastic surgery, thorax surgery, cardiac surgery, gastroenterology, and cardiology, to name a few.  

The basement floor of the training centre is used for hands-on training courses and the remaining floors are used as a convention centre for symposiums and meetings that have numerous auditoriums, meeting rooms, and lecture rooms with a capacity of changing between 50 to 230 people.

Istanbul is a very beautiful and attractive city that plays an important role because it is situated between Europe and Asia. The RMK AIMES training center and Koç University Hospital are in the European side of Istanbul where Istanbul Airport is also located, enabling easy international accessibility to the training centre. 

Certified by the EAU Robotic Urology Section (ERUS), the Koç University Hospital Department of Urology is a training centre that includes a team of high-volume robotic urologists who perform all types of procedures such as robotic upper urinary tract, robotic lower urinary tract and prostate, robotic renal transplantation, and robotic Retroperitoneal lymph node dissection (RPLND). This team actively uses the training centre (particularly in 2022 and 2023 after the COVID-19 pandemic) to organise many robotic urology courses, which are listed below.

Between 2022 and 2023, we had many faculty and participants in our courses attending from all around the world including Australia, Austria, Belgium, China, Denmark, Dubai, Egypt, France, Germany, India, Italy, Lebanon, Kuwait, the Netherlands, Poland, Saudi Arabia, Spain, Sweden, Switzerland, South Africa, Turkey, the United States, and the United Kingdom.

The first robotic urology course at RMK AIMES, the Robotic Retroperitoneal Upper Urinary Tract Surgery Human Fresh Frozen Cadaver Course, was held on 5 August 2022 at our training centre. Prof. Jens Rassweiler (AT) was invited as part of the faculty. In the past, I had the opportunity to receive training from Prof. Rassweiler at the SLK Kliniken Heilbronn in Germany.

From 31 August to 2 September 2023, we organised robotic, laparoscopic, and open surgery courses simultaneously. The University of Oxford and Koç University Urology faculties organised the Emergency Urology Course for residents in the cadaver lab of the training centre. The course involved open surgery activities on human fresh frozen cadavers. 

During the same period, we also organised human fresh frozen cadaver robotic radical prostatectomy and robotic radical cystectomy with intracorporeal ileal loop courses in the robotic surgery training operating room of the centre. Lastly, the laparoscopy upper urinary tract porcine model course was organised in the laparoscopic surgery training part of the training centre.

With the Da Vinci x surgical robotic system and two Da Vinci robotic simulators, we offer many robotic urology courses, which are as follows:

• 3D printed models: Partial nephrectomy on kidney models with renal masses, pyeloplasty on ureteropelvic junction obstruction models and on models for radical prostatectomy with urethra-vesical anastomosis.
• POP (pulsating organ perfusion) trainers: Cadaveric animal kidneys are used (with Indocyanine green [ICG] application) for partial nephrectomy.
• Porcine models (under anaesthesia with ICG application): Partial nephrectomy, nephrectomy, adrenalectomy, pyeloplasty, reconstructive procedures including uretero-neo-cystostomy and sacrocolpopexy. We can also offer robotic kidney transplantation courses on porcine models. 
• Human fresh frozen cadavers: Radical prostatectomy with pelvic lymph node dissection, radical cystectomy with intracorporeal urinary diversion, RPLND (supine and flank), upper and lower urinary tract surgical procedures including partial nephrectomy, nephrectomy, adrenalectomy,  pyeloplasty, and reconstructive procedures such as uretero-neo-cystostomy and sacrocolpopexy.

With nine laparoscopy towers, five pulsating organ perfusion (POP) trainers and nine laparoscopy training boxes with European Basic Laparoscopic Urological Skills (E-BLUS) training materials we offer many laparoscopic urology courses as follows:

• 3D printed models: Partial nephrectomy on kidney models with renal masses, pyeloplasty on UPJ obstruction models and on models for radical prostatectomy with urethra-vesical anastomosis.
• POP trainers: Cadaveric animal kidneys are used (with ICG application) for partial nephrectomy.
• Porcine models (under anaesthesia with ICG application): Partial nephrectomy, nephrectomy, adrenalectomy, pyeloplasty, reconstructive procedures, including uretero-neo-cystostomy and sacrocolpopexy. 
• Human fresh frozen cadavers: Radical prostatectomy with pelvic lymph node dissection, upper and lower urinary tract surgical procedures including partial nephrectomy, nephrectomy, adrenalectomy, pyeloplasty, and reconstructive procedures such as uretero-neo-cystostomy and sacrocolpopexy.

Endourology and stone surgery courses

Human fresh frozen cadavers can be used to offer flexible URS (uretero-renoscopy) with RIRS (retrograde intrarenal surgery) and laser application for urinary tract stones. We are able to insert stones into the renal pelvis one day before the course to enable this type of training. Similarly, we can also offer PNL (percurtaneous nephrolithotomy) course. Cadaveric animal urinary tract systems and/or other training models can also be used to offer similar courses.

Human fresh frozen cadavers can also be used for HoLEP (holmium laser enucleation of the prostate) courses and for prostate biopsy courses.

Open surgery courses

By using human fresh frozen cadavers, we can offer the Emergency Urology Course to present emergency urological procedures particularly to residents and trainees. In addition, artificial urinary sphincter and penile prosthesis insertion courses can also be provided.

To date, many urology associations and societies including the ERUS, SIU (Societe Internationale d’Urologie), the Turkish Association of Urology, ILRSA (International Laparoscopy and Robotic Surgery Association), IURES (International Urologic Research Society), and the Eur-Asian Urooncology Association which all took part in urology courses organised at our training centre. During our urology courses, we also like to include live music performances for our trainees and faculty. 

In conclusion, the RMK AIMES training centre in Istanbul offers many urology courses and is ready to increase collaboration with the EAU, ERUS, ESUT (EAU Section of Uro-Technology, EULIS (EAU Section of Urolithiasis), ESU (European School of Urology) and ESRU (European Society of Residents in Urology).  Situated in the same campus with Koç University Hospital, the centre can offer observation of live surgical procedures during the courses and/or organised events. In the same campus, an accommodation centre was recently built to offer lodging to course participants and faculty members.

References

1. Canda AE. Urology Around The World. Rahmi M. Koç Academy of Medicine, Education and Simulation Surgical Training Center in Istanbul. AUA News 2023; November: 1-4.
2. Canda AE. RMK AIMES: Training & Convention Center. Uronews 2022; June: 2.
3. Canda AE. RMK AIMES: Digital approach to medical education. Hospital Manager 2022;September-October: 51-54.