Francesco Del Giudice, Valerio Santarelli, Katarina Spurna, Syed Ghazi Ali Kirmani, Noor Ul Huda Bhatti, Mohamed Gad, Vincenzo ASERO, Benjamin I. CHUNG, Felice Crocetto, Benjamin CHALLACOMBE, Yasmin Abu‐Ghanem, Elsie Mensah, Youssef Ibrahim, Kathryn Chatterton, Suzanne Amery, Romerr Alao, John O’Kelly, Brian A. Parsons, Teck Wei Tan, Diarmaid Moran, Ella Doerge Unger, Sonpreet Rai, Marc A. Furrer, Jonathan Sean Kam, Rajesh Nair, Arun Sahai, Prokar Dasgupta, Ramesh Thurairaja, M Shamim Khan
Objective (1) To examine 10-yr outcomes of Robot-assisted Radical Cystectomy (RARC) with Intracorporeal Ileal Conduit (ICIC) performed by international clinical fellows within a 1-yr RCS-Eng Urothelial Senior Fellowship Programme. (2) To explore fellows’ learning curve (LC) trajectories and perceived European Association of Urology Robotic Urology Section (ERUS) RARC/ICIC curriculum competency achievement. Methods RARC/ICIC with curative intent for bladder cancer performed by supervised fellows (2015–2025) were reviewed. Perioperative outcomes and Kaplan-Meier survival trajectories served as surrogates of training competency and safety. Cumulative sum (CUSUM) model by operative time (OT) was applied for RARC/ICIC LC. Time to perceived proficiency across the 12 ERUS RARC/ICIC clinical modules was explored. Results A total of 423 procedures (median follow-up 39 mo, interquartile range 16–70) were included. Proficiency by CUSUM was identified at 30 th case, with significant reduction in total OT thereafter (350 vs 300 min, p = 0.017). Outcomes within learning and proficiency phases were comparable, including postoperative complications (36.6% vs 46.0%, p = 0.07), readmissions (16.9% vs 18.7%, p = 0.68), and cancer-specific survival ( p = 0.97). ERUS curriculum acquisition was progressive: early modules in 0–1 mo by 88.9% of fellows and advanced modules in 4–6 mo by 100%. Skin-to-skin RARC/ICIC was achieved within ≤3, 4–6, and >6 mo in 11.1%, 33.3% and 55.6% of fellows, respectively. Previous robotic exposure was the only predictor for shorter time to independence (odds ratio, 2.34; 95% confidence interval 1.17–13.29). Post-fellowship, 88.9% of fellows continued independent RARC/ICIC practice. Conclusions Structured Senior Robotic Fellowship training achieves safe and efficient acquisition of RARC/ICIC skills. The observed LC corroborates the educational value of the ERUS modular curriculum in the setting of a tertiary referral center.