Learning Curve of Robotic Assisted Pyeloplasty for Pediatric Urology Fellows

Abstract

DISCLAIMER Purpose Little is known about the learning curve of robotic surgery for surgeons-in-training. We hypothesized that pediatric urology fellows could attain proficiency in robotic pyeloplasty, defined as an operative time equivalent to that of an experienced robotic surgeon, within the two-year time frame of fellowship. Material and Methods From 2006 – 2010, we performed a prospective cohort study of four pediatric urology fellows and one pediatric urology attending performing pediatric robotic pyeloplasty. The operative times and surgical outcomes of 20 consecutive robotic pyeloplasties performed by four pediatric urology fellows (n = 80 cases) and a random sample of 20 cases performed by the attending surgeon were recorded. Multivariate linear regression was used to determine the change in operative time for each case the fellows performed and to estimate the number of cases necessary for fellows to achieve the median operative time of the attending pediatric urologist. Results The fellows’ operative times decreased at a constant rate of 3.7 minutes on average per case (95% CI 3.0 – 4.3 min/case). Fellows were projected to achieve the median attending operative time after 37 cases. No operative complications or failed pyeloplasties occurred. Conclusions Operative times for robotic pyeloplasty performed by fellows consistently decreased with cumulative surgical experience. These data can be used to help establish benchmarks of robotic pyeloplasty in pediatric urology assuming an appropriate exposure to robotics and an adequate case volume.

Systematic review of learning curves in robot-assisted surgery

“…These terms, however, were used inconsistently or interchangeably 36,50 , or used with distinct definitions 33,49 . These terms, however, were used inconsistently or interchangeably 36,50 , or used with distinct definitions 33,49 .…”

“…In 13 of 14 studies (93 per cent) that employed performance terms, at least one term was used to describe the point where the learning curve had been overcome; 'proficiency' was used for this purpose in ten studies 22,27,28,31,36,38,39,42,50,55 , 'competency' in five studies 10,27,33,36,49 and 'expertise' in one study 50 . However, these terms were used inconsistently.…”

Simulation for Pediatric Surgery and Surgical Specialties

“…Since volume-outcome relationships are a well-described phenomenon across multiple surgical specialties, a drop in cases gives pause for concern. Indeed superior outcomes have been demonstrated in association with volume or specialty training for pediatric extracorporeal membrane oxygenation (ECMO) [10,11], pyloromyotomy [12,13], appendectomy [14], urology [15,16], and cardiac surgery [17].…”

Update on the Minimally Invasive Approach in Paediatric Urology: Remote Help for Human Hands?

“…The learning curve has been shown to be shorter, with outcomes comparable to those of open procedures [35,51,52]. Many publications have reported that the introduction of robotics after a well-conducted training program is safe and effective [53,54]. In a recent prospective cohort study to determine the learning curve for paediatric urology fellows in paediatric robotic pyeloplasty, the authors concluded that the operative time for robotic pyeloplasty performed by fellows consistently decreased with cumulative surgical experience [54].…”

“…Many publications have reported that the introduction of robotics after a well-conducted training program is safe and effective [53,54]. In a recent prospective cohort study to determine the learning curve for paediatric urology fellows in paediatric robotic pyeloplasty, the authors concluded that the operative time for robotic pyeloplasty performed by fellows consistently decreased with cumulative surgical experience [54]. Another recent publication highlighted the value of a multitechnique robotic training curriculum including dry-lab in addition to virtual and clinical training in the use of the robotic platform [55].…”