Learning Curves in Pediatric Robot-Assisted Pyeloplasty: A Systematic Review

Abstract

Background: Robot-assisted surgery demands a specific skillset of surgical knowledge, skills, and attitudes from the robotic surgeon to function as part of the robotic team and for maximal utility of the assistive surgical robot. Subsequently, the learning process of robot-assisted surgery entails new modes of learning. We sought to systematically summarize the published data on pediatric robot-assisted pyeloplasty (pRALP) to decipher the learning process by analyzing learning curves. Methods: This review followed the PRISMA guidelines. PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched for ‘learning curve’ AND ‘pediatric pyeloplasty’. All studies presenting outcomes of learning curves (LC) in the context of pRALP in patients < 18 years of age were included. Studies comparing LC in pRALP versus open and/or laparoscopic pyeloplasty were also included; however, those solely focusing on LC in non-robotic approaches were excluded. The methodological quality was assessed using the Newcastle and Ottawa scale. Results: Competency was non-uniformly defined in all fifteen studies addressing learning curves in pRALP. pRALP was considered safe at all stages. Proficiency in pRALP was reached after 18 cases, while competency was estimated to demand 31 operated cases with operative duration as outcome variable. Conclusions: Pediatric RALP is safe during the learning process and ‘learning by doing’ improves efficiency. Competencies with broader implications than time must be defined for future studies.

Cumulative sum analysis of ultrasound-guided distal radial artery cannulation for invasive blood pressure monitoring: Three operators experience

“…"Learning curves" originated in industry and has since been applied to many elds, which has led to the widespread use of this term in medical eld [9,10]. Many individual learning curves for a particular procedure are similar, and these curves can be used to guide future training [11].…”

The construction of a nomogram to predict the prognosis and recurrence risks of UPJO

“…The consensus published by European Association of Urology (EAU) showed that surgeons could proficiently perform laparoscopic pyeloplasty after implementing the surgery for 50 cases. Niklas Pakkasjärvi ( 46 ) found that surgeons were adept at robotic-assisted laparoscopic pyeloplasty after implementing the surgery for 31 cases. This suggested that surgeon proficiency in both procedures should also be regarded as a risk factor for the prognosis and recurrence of UPJO ( 54 , 55 ).…”

“…As revealed in several studies (46)(47)(48)(49)(50)(51)(52)(53), open pyeloplasty, laparoscopic pyeloplasty, and robot-assisted laparoscopic pyeloplasty may generate different curative effects. Meanwhile, the proficiency of surgeons was also one of the factors affecting the curative effects.…”

Small Scale, High Precision: Robotic Surgery in Neonatal and Pediatric Patients—A Narrative Review

“…To excel in the dynamic field of robotic-assisted surgery, surgeons and nurses can benefit from specialized courses and workshops designed to enhance their skills and proficiency [ 33 ]. Comprehensive training programs often cover various aspects, including system operation, instrument manipulation, and troubleshooting, ensuring healthcare professionals are well equipped to navigate the intricacies of robotic platforms [ 23 , 34 ].…”