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Background:Robotic-assisted laparoscopic pyeloplasty (RALP) has become the gold standard approach to ureteropelvic junction obstruction (UPJO). Previous studies showed that RALP have a shorter hospital stay and less use of painkillers compared to open surgery. Some studies describe the learning curve of RALP in children, but to our knowledge, no data describes the learning curve (LC) of RALP in adult patients. We aimed with this study to evaluate the LC of a single surgeon doing RALP operations for an adult patients group. Three critical steps to overcoming the learning curve are preoperative education, intraoperative technique, and postoperative care.Methods:Retrospectively, we reviewed the medical record of 28 consecutive patients who underwent RALP in the period between September 2017 and June 2021. All surgeries were done by a single surgeon. We are focusing on operative time to identify the lærning point. Spline regression and CUSUM-Operative time analysis were done to calculate the flexion points (learning points).Results:Tweenty eight patients with UPJO underwent RALP. Sixteen (61%) patients were female, and the mean age was 44 (SD:18). The median BMI was 26 (IQR:22-32).The CUSUM graph showed that competency could be achieved after 8 cases and proficiency after 16 cases. Regression analysis showed significant decreases in the consecutive operative time by 6.50 minutes 95% CI (11-2 minutes), p-value 0.009, for the first sixteen cases, with no significant difference for the last ten cases, p-value 0.87.Conclusions:Analysis of LC of our data suggests that sixteen cases would be enough to achieve proficiency in the RALP regarding operative time. More studies are needed to identify the learning curve according to complications and functional outcomes. The single surgeon learning curve of Robotic-Assisted Laparoscopic Pyeloplasty (RALP)Alhusseinawi, Hayder1,2; Schoenike, Celi1; Lundahl Camilla1; Petersen, Helle H.1; Azawi, Nessn3,41 Department of Urology, Aalborg university hospital, Aalborg, Denmark2 Department of clinical medicine, Aalborg University, Aalborg, Denmark3 Department of urology, Sjælland University Hospital, Roskilde, Denmark4 Department of clinical medicine, Copenhagen University, Copenhagen, DenmarkBackground:Robotic-assisted laparoscopic pyeloplasty (RALP) has become the gold standard approach to ureteropelvic junction obstruction (UPJO). Previous studies showed that RALP have a shorter hospital stay and less use of painkillers compared to open surgery. Some studies describe the learning curve of RALP in children, but to our knowledge, no data describes the learning curve (LC) of RALP in adult patients. We aimed with this study to evaluate the LC of a single surgeon doing RALP operations for an adult patients group. Three critical steps to overcoming the learning curve are preoperative education, intraoperative technique, and postoperative care.Methods:Retrospectively, we reviewed the medical record of 28 consecutive patients who underwent RALP in the period between September 2017 and June 2021. All surgeries were done by a single surgeon. We are focusing on operative time to identify the lærning point. Spline regression and CUSUM-Operative time analysis were done to calculate the flexion points (learning points).Results:Tweenty eight patients with UPJO underwent RALP. Sixteen (61%) patients were female, and the mean age was 44 (SD:18). The median BMI was 26 (IQR:22-32).The CUSUM graph showed that competency could be achieved after 8 cases and proficiency after 16 cases. Regression analysis showed significant decreases in the consecutive operative time by 6.50 minutes 95% CI (11-2 minutes), p-value 0.009, for the first sixteen cases, with no significant difference for the last ten cases, p-value 0.87.Conclusions:Analysis of LC of our data suggests that sixteen cases would be enough to achieve proficiency in the RALP regarding operative time. More studies are needed to identify the learning curve according to complications and functional outcomes.

Validerat; 20140121 (global_studentproject_submitter)