Mp73-08 the Learning Curve for Minimally Invasive Pyeloplasty in Children—a Video Analysis

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (MP73)1 May 2024MP73-08 THE LEARNING CURVE FOR MINIMALLY INVASIVE PYELOPLASTY IN CHILDREN—A VIDEO ANALYSIS Rawin Amiri, Maurice J. W. Zwart, Marc G. Besselink, Harrie P. Beerlage, Hendricus J. R. van der Horst, Rafal J. Chrzan, Caroline F. Kuijper, and Luitzen A. Groen Rawin AmiriRawin Amiri , Maurice J. W. ZwartMaurice J. W. Zwart , Marc G. BesselinkMarc G. Besselink , Harrie P. BeerlageHarrie P. Beerlage , Hendricus J. R. van der HorstHendricus J. R. van der Horst , Rafal J. ChrzanRafal J. Chrzan , Caroline F. KuijperCaroline F. Kuijper , and Luitzen A. GroenLuitzen A. Groen View All Author Informationhttps://doi.org/10.1097/01.JU.0001009564.26544.1c.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive (i.e. robot-assisted -and non-robotic laparoscopy) dismembered pyeloplasty (MIDP) has become a popular and successful approach for ureteropelvic junction obstruction treatment in pediatrics. Reports on MIDP shows safety, shorter length of hospital stay and efficacy compared to the conventional approach. However, there is limited data on the learning curve for MIDP. Therefore, our objective is to assess the learning curve of MIDP in pediatric patients with ureteropelvic junction obstruction by utilizing the objective structured assessment of technical skills (OSATS, attainable score 12-60) score with cumulative sum (CUSUM) analysis. METHODS: Observational single center retrospective study including all consecutive MIDPs (November 2015 and December 2022). Videos of robot-assisted- (RA) and non-robotic pyeloplasties (NRA) were rated using the OSATS-score. CUSUM-analysis was used to establish the median number of procedures to reach a turning point. The differences before- and after the turning point were assessed for operative time, conversion-, and complication rate. RESULTS: Overall, 56 procedures were included, 26(46%) RA with a mean operative time of 245(±85) minutes and 30(54%) NRA with a mean operative time of 253(±81) minutes. A total of 44(79%) videos were recorded (21 RA and 23 NRA). Complications occurred in 4/44 patients (9%), two of whom experienced minor- (2/44, 4.5%) and two major complications (2/44,4.5%). Mean OSATS-score was 45.1(±8.8) points and CUSUM analysis identified a turning point of 19 MIDP procedures. After the turning point, the mean OSATS score increased from 37.8(±5.9) to 47.4(±8.3) points, 25.4%, p=.032. The occurrence of conversions was eliminated after the turning point: 4/19 (21.0%) vs 0/25 )0%), p=.029). Outcomes after RA were favorable, e.g., no necessity for conversion and absence of major complications. CONCLUSIONS: In this single center series, MIDP appears to be safe and effective in pediatric patients. This is especially apparent in the robot assisted group. After the learning curve turning point of 19 procedures, both conversions and major complications decreased. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1185 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rawin Amiri More articles by this author Maurice J. W. Zwart More articles by this author Marc G. Besselink More articles by this author Harrie P. Beerlage More articles by this author Hendricus J. R. van der Horst More articles by this author Rafal J. Chrzan More articles by this author Caroline F. Kuijper More articles by this author Luitzen A. Groen More articles by this author Expand All Advertisement PDF downloadLoading ...