Learning Curve of Robotic-Assisted Laparoscopic Pyeloplasty (RALP) in Children: How to Reach a Level of Excellence? - Beyond the Abstract

Studying the learning curve of a surgical procedure has increased in popularity in recent years. Bearing in mind that this concept is elusive, many groups have tried to formularize different definitions throughout the years. 



Reviewing all publications on the learning curve of robotic-assisted laparoscopic pyeloplasty (RALP), we have noticed that the learning curve suggested is much longer than that we experienced. It has been suggested that up to 40 cases of RALP are required to reach the operative results equal to that of open surgery. However, the data in our practice demonstrated different results.

Therefore, we hypothesized that the previous experience our surgeon had in open and laparoscopic surgeries might shorten the learning curve of robotic surgery.

We have retrospectively evaluated the data of all children who underwent pyeloplasty in our institute by a single surgeon since 2003. The children were divided into three groups: open pyeloplasty, laparoscopic pyeloplasty, and RALP. The groups were ordered chronologically by the operation date and each group was divided into two different phases: early and late. A comparison was made between the data of the early and the late phase.

We found that indeed the previous experience in open and laparoscopic surgery may contribute to a shorter learning curve of robotic surgery required for the surgeon to achieve a similar outcome to that of open surgery with comparable complications rate.

Written by: David Dothan, MD, Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of the Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

References:

  1. Tasian, Gregory E., Douglas J. Wiebe, and Pasquale Casale. "Learning curve of robotic assisted pyeloplasty for pediatric urology fellows." The Journal of urology 190, no. 4 (2013): 1622-1627.
  2. Sorensen, Mathew D., Catherine Delostrinos, Michael H. Johnson, Richard W. Grady, and Thomas S. Lendvay. "Comparison of the learning curve and outcomes of robotic assisted pediatric pyeloplasty." The Journal of urology 185, no. 6 (2011): 2517-2522.
  3. Cundy, Thomas P., Nicholas E. Gattas, Alan D. White, and Azad S. Najmaldin. "Learning curve evaluation using cumulative summation analysis—a clinical example of pediatric robot-assisted laparoscopic pyeloplasty." Journal of pediatric surgery 50, no. 8 (2015): 1368-1373.
  4. Kassite, I., K. Braik, T. Villemagne, H. Lardy, and A. Binet. "The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach." Journal of pediatric urology 14, no. 6 (2018): 570-e1.
  5. Scarlett, A. L., A. Mentessidou, M. K. Farrugia, D. De Caluwé, and Nisha Rahman. "Urology robotic journey: demonstrating the learning curve in robot-assisted pyeloplasties (RALP)." Journal of Pediatric Endoscopic Surgery 1, no. 2 (2019): 79-82.
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