Retrospective study reveals high reflux resolution and low complications in pediatric ureteral reimplantation, indicating surgical proficiency is safely attained within a modest case volume.
Key Points
To characterize the learning curve, radiographic efficacy, and safety profile of robotic-assisted laparoscopic ureteral reimplantation using the LUAA extravesical technique for primary vesicoureteral reflux.
Conducted a retrospective single-surgeon study of 125 pediatric patients undergoing RALUR for primary vesicoureteral reflux across three developmental eras: pre-LUAA (2008–2011), evolving LUAA (2011–2014), and standardized LUAA (2014–2025).
Evaluated primary radiographic resolution on postoperative voiding cystourethrogram alongside secondary outcomes of urinary retention and 90-day Clavien-Dindo grade ≥3 complications.
Applied cumulative sum (CUSUM) analysis of operative times to determine objective cutoffs for surgical competency, proficiency, and mastery.
Radiographic reflux resolution improved from 76.0% in the pre-LUAA phase to 85.2% in the evolving phase and 94.4% in the standardized phase, achieving an overall resolution rate of 87.2%.
Postoperative complication rates remained low, with urinary retention occurring in 4.0% of patients and Clavien-Dindo grade ≥3 complications occurring in 3.2%.
CUSUM analysis identified surgical competency at case 28 and procedural mastery at case 99 across the overall cohort.