Medical Education Programmes
Clinical Visit – Female Reconstructive Urology in the USA
by Ben Challacombe MS FRCS (Urol), Urology Foundation Robotic Training Fellow
Urology is a technology-driven specialty, and minimally invasive surgery is becoming an increasing part of the modern urologist’s armoury. With recent increases in the diagnosis of localised prostate cancer due to PSA testing and better patient awareness, there has been a focus on treatments that can reduce the potential side effects to patients while maintaining good cancer control.
Robotic-assisted radical prostatectomy is increasingly seen as a particularly good treatment option for men in this situation. The procedure itself is technically challenging and requires a surgeon with a sound background in urological cancer surgery who has been fully trained on the da Vinci robotic system. At present there are only a small number of da Vinci systems in the UK (around 14) and consequently there are relatively few training centres for this demanding technique.
I am a 6th and final year urology registrar on the South East Thames training rotation. Having completed a Master of Surgery thesis in robotic technology, I became involved in the robotic surgery programme at Guy’s and St Thomas’ Hospitals in 2004.
During my early registrar training years, I applied for a British Urological Foundation 3-year robotic training grant, which had been generously funded by a former patient. This grant was set up to sponsor a trainee surgeon to become fully trained and accredited in robotic-assisted radical prostatectomy and other robotic procedures. Once proficient, the urologist can then train others in this area, so transferring these complex skills.
The Royal Melbourne Hospital – Providing Robotic Prostatectomy Training for Urologists Worldwide
After I completed 2 years of robotic prostatectomy and laparoscopic training at Guy’s Hospital, I applied for a 1- year urology fellowship at the Royal Melbourne Hospital in Australia to undertake advanced robotic prostatectomy training. This prestigious position is under the tutelage of Professor Anthony Costello, an internationally renowned urologist, and is a well trodden path for ambitious trainees; many urologists well known for robotic prostatectomy have trained in this unit before practising in their countries of origin.
Having a sound basis in laparoscopic and robotic procedures before my arrival in Melbourne enabled me to advance rapidly onto the da Vinci console and begin performing elements of the operation independently. I am now able to perform a robotic prostatectomy under supervision; by the end of my fellowship here I hope to have been involved in 100 cases and to be accredited as an independent robotic prostatectomist.
I am currently at the mid point of my year in Australia and the fellowship has already far exceed the high expectations I had for it. My operating schedule is dominated by robotic-assisted laparoscopic radical prostatectomies of which I assist/perform two to four per week. I also have a laparoscopic operating list once weekly where I now independently perform and teach laparoscopic kidney removals or other major open cases.
I have one or two other lists per week where I schedule a variety of additional procedures including laser prostate surgery for bladder outflow obstruction. The fellowship is very focused on surgical activity, with one general urology clinic each week and one bladder endoscopy list. I have excellent support from two international fellows, a urology registrar and a number of residents who look after in-patients and clinics.
Recognising Leaders in Their Home Country
The academic highlight of my first 6 months has been the award of the UK and Ireland Rowan Nicks Fellowship from the Royal Australasian College of Surgeons. The most prestigious of the College’s International Awards, these are directed at surgeons who have the potential to be ‘leaders in their home country in their chosen surgical speciality area’. This Fellowship was formally presented to me by the President of the Australasian College of Surgeons at the College’s Annual Scientific Congress in Brisbane in April 2009.
Training in Australia encourages UK specialist registrars to gain a set of skills that are both different from and complementary to those developed in the UK. There is a greater emphasis on becoming an independent urologist who is able to perform a wide range of complex procedures, and consequently the operative exposure is diverse and challenging. In addition an Australian fellowship allows exposure to an entirely different healthcare system, which has both advantages and disadvantages compared with the NHS. As a result of my period here, I have independently carried out a number of other advanced urological procedures including laparoscopic and roboticassisted pyeloplasty, open cystectomy, laparoscopic and open nephrectomy, penile fracture repair, green-light PVP TURPs and a number of laparotomies.
Passing On More Than Just Surgical Skills
This fellowship provides an opportunity for the surgeon to develop the skills necessary to manage a department, become competent in the teaching of others, gain experience in clinical research and the application of robotic technology and obtain advanced exposure to general and specialist urological surgery. I look forward to returning to the UK with these skills and disseminating them to those with whom I work to improve the treatment of patients with prostate and other urological cancers.
With my wife Sarah and our two sons, we are very much enjoying life in Melbourne. The city is lovely; people are very friendly; the weather is generally very pleasant although very hot at times. We have travelled in Victoria and visited several other states and often spend time with other international fellows with whom I have forged strong and long-lasting professional and personal relationships.
As a keen runner and cyclist I have taken part in a number of charity events and I look forward to directing my efforts towards fundraising for the Urology Foundation when I return to the UK to put something back into the charity. I am extremely grateful to the Foundation for this generous support, without which my robotic training and Australian Fellowship would not have been possible.
