The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach

Kassite, I.; Braik, Karim; Villemagne, T.; Lardy, H.; Binet, Aurélien

doi:10.1016/j.jpurol.2018.07.019

Cited by 28 publications

(24 citation statements)

References 22 publications

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“…In essence, OT is not a reliable measure of learning, and OT alone may not be a useful indicator of good practice (19). Kassite et al have evaluated the learning curve (LC) over a 10 year period for RALP in children by adopting a multidimensional approach and accounting for patient complexity factors (20). Using the cumulative sum (CUSUM) methodology analyzing multi-outcome parameter, they showed that there were three separate phases for the LC in RALP.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Approach for Ureteropelvic Junction Obstruction: Encouraging Preliminary Results With Robot-Assisted Laparoscopic Repair

et al. 2019

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Introduction stating the aim of the study: Robot-assisted laparoscopic pyeloplasty (RALP) is gaining acceptance among pediatric urologists. Few studies have evaluated the retroperitoneal approach for RALP. We share our experience from the first 2 years of a multidisciplinary pediatric robotic program in our center. Patients (or Materials) and Methods: We performed a retrospective analysis of prospectively collected data of children undergoing RALP for ureteropelvic junction obstruction ( n = 50). Diagnosis was confirmed by ultrasound and Tc-99m mercaptoacetyltriglycine renal scan or MRI; the same criteria were used to evaluate outcome. Surgical approach was chosen according to a specific algorithm. Transperitoneal approach ( n = 13) was reserved for horseshoe kidney, ectopic kidney, and redo surgery. We analyzed the 37 cases performed by a lateral retroperitoneal approach. Dismembered pyeloplasty was done for all cases and anastomosis was performed using a running monofilament 6/0 absorbable suture. All were drained by double J stent. Patient data, operating room parameters and postoperative course were recorded. Results: The median age was 7.9 years (5.1–13.8); the youngest was 2 years old. The median weight was 23 kg (17–41) with the smallest weighing 12.4 kg. Aberrant crossing vessels were present in 18 children. Median set-up time, from skin incision until the end of the 4-port insertion, was 33 min (29–48). Median surgeon's console time was 151 min (136–182). No conversion to an open procedure was necessary. The postoperative course was free of complications, except urinary tract infection in 6 children. All but 4 patients were discharged on day one. Median follow-up was 9 months (5–13). Redo pyeloplasty was not required. Practical training of other colleagues was possible after 10 cases performed by the same surgeon. Conclusion: These preliminary results suggest that retroperitoneal RALP in children is feasible, safe and effective. It is an excellent option with ideal anatomical exposure. Longer term results as well as continued practice will identify and overcome any challenges and enable surgical mastery of this procedure which is still evolving.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneal Approach for Ureteropelvic Junction Obstruction: Encouraging Preliminary Results With Robot-Assisted Laparoscopic Repair

et al. 2019

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“…More than about 40 RALP cases are needed to achieve mastery, a significant reduction in OT, length of stay, and postoperative pain. 54,55 Bowen et al evaluated the role of proctoring and of an established robotic program and found that an experienced open surgeon and fellowship-trained surgeon can quickly attain levels of expertise with paediatric RALP. 56 Laparoscopic surgery can be technically more challenging than robotics, but it also has the advantage of no docking and precise learning of how robots and consoles work.…”

Section: Learning Curve and Surgeon's Perspectivementioning

confidence: 99%

“…More than about 40 RALP cases are needed to achieve mastery, a significant reduction in OT, length of stay, and postoperative pain. 54 , 55 …”

Section: Learning Curve and Surgeon’s Perspectivementioning

confidence: 99%

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Mantica¹,

Ambrosini²,

Parodi³

et al. 2020

RRU

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Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon’s preference or experience, and on institutional availability.

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“…Not surprisingly, they found that complexity factors influenced surgical outcomes. After looking at patient complexity factors and the perioperative data, they felt that more than 41 cases are needed to achieve mastery (30).…”

Section: Technical Challenges Of Infant Robotic Surgerymentioning

confidence: 99%

Robotic Urologic Surgery in Infants: Results and Complications

Kim

2019

Front. Pediatr.

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Over the last 30 years, robotic surgery has evolved into the preferred surgical approach for many operative cases. Robotics has been associated with lower pain scales, shorter hospitalizations, and improved cosmesis ( 1 , 2 ). However, its acceptance in pediatrics have been hampered by longer operative times, smaller working space, and limited fine surgical instruments. Many find these challenges even more pronounced when performing robotic surgery in infants (i.e., children <1 year old). Although the data in infants is less robust, many studies have shown benefits similar to the adult population. Specifically, multiple reports of robotic surgery in infants have shown lower postoperative analgesic use. Additionally, hospital stays are shorter, which may lead to quicker return to work for parents and guardians. Multiple reports have shown low complication rates of robotic surgery in infants. When complications have occurred, they are usually Clavien Grade 1 and 2, with occasional grade 3. Often the complications are not from the robotic technique, but are linked to other factors such as the ureteral stents ( 3 , 4 ). Most importantly, the success rates of surgery are comparable to open surgery. This chapter will review indications for the most common urologic robotic surgeries performed in infants. Also, we will review reported results and complications of robotic surgery in children, with specific attention to the infant population. However, data focused only on infants is limited. Many studies have some infant patients, but their results are often mixed with all pediatric patients.

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The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach

Cited by 28 publications

References 22 publications

Retroperitoneal Approach for Ureteropelvic Junction Obstruction: Encouraging Preliminary Results With Robot-Assisted Laparoscopic Repair

Retroperitoneal Approach for Ureteropelvic Junction Obstruction: Encouraging Preliminary Results With Robot-Assisted Laparoscopic Repair

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Robotic Urologic Surgery in Infants: Results and Complications

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