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The learning curve for robotic-assisted pyeloplasty in children: Our initial experience from a single center.


ABSTRACT:

Background

Robotic-assisted pyeloplasty surgery has become the preferred approach of ureteropelvic junction obstruction (UPJO) in pediatrics. However, to our knowledge, there is limited data on the learning curve for robotic-assisted pyeloplasty in children and no similar study from Saudi Arabia.

Aims

The objective of the study was to evaluate the progression of the surgical team performing robotic-assisted laparoscopic pyeloplasty (RALP) and to assess the feasibility of the RALP in children, since it is having been recently started in the Kingdom.

Settings and design

Retrospective charts and surgical videos review at the tertiary care centre.

Subjects and methods

After approval from the internal review board (IRB), we reviewed the surgical video recording of the RALP procedure of 15 patients presented with UPJO from January 2016 to October 2017. Statistical analysis was done for the variables includes dissection time, pyelotomy, anastomosis on both sides, and total surgery time and calculated in minutes. Renal ultrasound reviewed to assess any change in grade.

Results

Fifteen patients with UPJO underwent RALP. Of 15 cases, nine were primary and six cases as secondary UPJO. The median age was 8 (3-15) years. Out of 15 cases, 13 and 2 patients diagnosed as Society for Fetal Urology grades of 4 and 3, respectively. Total operative time was prolonged in secondary group as compared to primary pyeloplasty group (mean [standard deviation (SD)]: 166.3 [35.1], range: 125-223, P = 0.0028 versus mean (SD): 149.17 (30.4), range: (114-207), P = 0.0008). The success rate was 100% in primary and 84% in secondary cases. The median length of follow-up was 12.0 (7.0-18.0) and 10.0 (8.0-12.5) months in primary and secondary cases, respectively. The overall complication rate was 13% (2/15) (Clavien grade: 1-2).

Conclusions

The evaluation of the learning curve of RALP for this group of patients concluded that total operative time for RALP, performed by the pediatric urology team, steadily decreased with collective surgical experience.

SUBMITTER: Junejo NN 

PROVIDER: S-EPMC6978967 | biostudies-literature | 2020 Jan-Mar

REPOSITORIES: biostudies-literature

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Publications

The learning curve for robotic-assisted pyeloplasty in children: Our initial experience from a single center.

Junejo Noor Nabi NN   Alotaibi Anwar A   Alshahrani Saeed Malwi SM   Alshammari Ahmad A   Peters Craig A CA   Alhazmi Hamdan H   Vallasciani Santiago A SA  

Urology annals 20191223 1


<h4>Background</h4>Robotic-assisted pyeloplasty surgery has become the preferred approach of ureteropelvic junction obstruction (UPJO) in pediatrics. However, to our knowledge, there is limited data on the learning curve for robotic-assisted pyeloplasty in children and no similar study from Saudi Arabia.<h4>Aims</h4>The objective of the study was to evaluate the progression of the surgical team performing robotic-assisted laparoscopic pyeloplasty (RALP) and to assess the feasibility of the RALP  ...[more]

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