Robotic pyeloplasty learning curve for a pediatric surgeon without previous laparoscopic pyeloplasty experience

INTRODUCTION: Robotic pyeloplasty has become a technique of choice for pyelo-ureteral junction syndrome treatment in children. Less invasive than open surgery, robotic pyeloplasty also has a lower learning curve than laparoscopic pyeloplasty. This is how a new generation of surgeons without previous laparoscopic pyeloplasty experience has begun training in robotics. PURPOSE: To assess the robotic-assisted pyeloplasty learning curve for a pediatric surgeon only trained in open pyeloplasty, and to investigate if that mode of practice is safe and effective. METHODS: Data was collected from all children operated on for pyelo-ureteral junction syndrome by the same surgeon in our center between 2015 and 2021. Cases were divided into 4 groups of 14 consecutive procedures to analyze the learning curve. RESULTS: 56 patients were operated on, with a median (IQR) age, weight and hospital stay of 9 years and 1 month old (3.5), 29 kg (17.3), and 3 days (2) respectively. The mean ± SD operative times were 146.5 ± 39.3, 123.2 ± 48.1, 103.1 ± 29.5, and 141.7 ± 25.0 minutes, with a unique significant difference between groups 1 and 3 (p=0.007**). Only two intraoperative and nine postoperative complications were observed. The surgery was successful in 98% cases. CONCLUSION: Our study shows that a significant improvement in surgical time could be achieved in the first 30 cases, safely and efficiently even without previous laparoscopic pyeloplasty experience.