Optimizing outcomes in laparoscopic urologic training: toward a standardized global consensus.

BACKGROUND AND PURPOSE: Laparoscopic urologic surgery (LUS) is one of the fastest growing subspecialties in the surgical world. The procedures require technical expertise and finesse; unlike their open counterparts, there is significant limitation in the margin for error. Various ethical, medicolegal, and health economy demands have made training in laparoscopic urologic surgery challenging. Whereas several groups have sought solutions through models, there remains a lack of consensus on the optimal training program. We review the current LUS programs with a conscious effort to decipher the basic tenets of an optimal training program and propose training models based on published evidence, in conjunction with current trends in LUS. METHODS: A literature search of MEDLINE, Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Google Scholar was performed, seeking publications from January 1970 to July 2006 on laparoscopic surgical training pertaining to urology. Additionally, we looked at pertinent abstracts of the annual meetings of the American Urological Association, the European Association of Urology, and the World Congress of Endourology for the period January 1996 to and inclusive of August 2006. RESULTS AND CONCLUSIONS: To date, no study has documented a global consensus on optimal LUS training programs. Our search identified several models, some of which were applied successfully in the form of minifellowships. There remain no clear guidelines on the optimum LUS training program. The optimal program may need to be tailored to individual units, based on resources (this includes country-specific health economics, mentor availability, and caseload). Further studies are needed to help elucidate how individual programs can be initiated with a global minimum standard applicable to all training programs.