**4. Robotic surgeon training**

Robot-assisted surgery is rapidly gaining popularity among urologists and is becoming subspecialised. Generally the three main categories that need fellowship or hands-on training are prostatectomy, partial nephrectomy, and radical cystectomy. It is not acceptable to begin robotic surgery without the appropriate training [7]. Currently, robot-assisted radical prostatectomy is the most commonly performed robotic procedure worldwide. There is mounting evidence that the robot assistance provides significant benefits to the patient and surgeon, especially shortening operating time and surgeon fatigue [2]. There has been a major shift of treatment of prostate cancer by surgery in wealthier countries from open to a laparoscopic approach, and now robotic. A modern comparison is with radical nephrectomy in the 1990s.

The learning curve to deliver laparoscopic radical prostatectomy (LRP) is estimated at 40–60 cases with skilled surgeons and 80–100 cases, with inexperienced surgeons. The robot shortens the prostatectomy learning curve for all surgeons, particularly experienced open prostatectomists. Interestingly, a surgeon skilled in open surgery was able to transfer his open skills to robotic surgery in 8**–**12 cases [8]. However, currently we recommend fellowship training such as the ERUS-approved programmes (**Figure 1**).

A fellowship-trained laparoscopic surgeon has a similar, short learning curve for robotic prostatectomy compared to an experienced open surgeon. The data showed a safe and reproducible surgery, interestingly even during the learning curve. Importantly, the outcomes were the same for early robotic surgery and a large cohort of open prostate surgery [8]. There was an emphasis on having a good mentor, experienced in robotics being present during the initiation of the programme.
