Faculty Opinions recommendation of Can proctoring affect the learning curve of robotic-assisted laparoscopic pyeloplasty? Experience at a high-volume pediatric robotic surgery center.

Abstract Background The aim of this study is to compare the results of laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Methods Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Results Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs 2 days, respectively, P = 0.029). Conclusions Laparoscopic and robotic-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

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1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series

British Journal of Surgery ◽

10.1093/bjs/znab259.794 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Ng ◽

A Nathan ◽

N Campain ◽

Y Yuminaga ◽

F Mumtaz ◽

...

Keyword(s):

Robotic Surgery ◽

Anatomical Variation ◽

High Volume ◽

Perioperative Outcomes ◽

Open Approach ◽

Robot Assisted ◽

Renal Masses ◽

Robotic Assisted ◽

Robotic Assisted Surgery ◽

Estimated Blood Loss

Abstract Introduction Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Method Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate). Results The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients. Conclusions We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.

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299 INSTITUTIONAL AND SURGEON-SPECIFIC LEARNING CURVE ANALYSIS OF 350 ROBOTIC-ASSISTED ESOPHAGECTOMIES AT A HIGH VOLUME CANCER CENTER.

Gastroenterology ◽

10.1016/s0016-5085(20)34430-9 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1504-S-1505

Author(s):

David T. Pointer ◽

Sabrina Saeed ◽

Jacques-Pierre Fontaine ◽

Sean Dineen ◽

David Boulware ◽

...

Keyword(s):

Learning Curve ◽

High Volume ◽

Curve Analysis ◽

Cancer Center ◽

Robotic Assisted ◽

Specific Learning

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MP71-10 LEARNING CURVE OF ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY (RALP) IN CHILDREN, HOW TO REACH A LEVEL OF EXCELLENCE?

The Journal of Urology ◽

10.1097/ju.0000000000000951.010 ◽

2020 ◽

Vol 203 ◽

pp. e1067

Author(s):

David Dothan* ◽

Galia Raisin ◽

Jawdat Jaber ◽

Stanislav Kocherov ◽

Boris Chertin

Keyword(s):

Learning Curve ◽

Laparoscopic Pyeloplasty ◽

Robotic Assisted

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Evaluation of Robotic-Assisted Laparoscopic and Open Pyeloplasty in Children: Single-Surgeon Experience

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925058797 ◽

2015 ◽

Vol 97 (2) ◽

pp. 109-114 ◽

Cited By ~ 15

Author(s):

P Murthy ◽

JA Cohn ◽

MS Gundeti

Keyword(s):

Epidural Analgesia ◽

Learning Curve ◽

Clinical Success ◽

Laparoscopic Pyeloplasty ◽

Robotic Assisted ◽

Urologic Surgery ◽

Presenting Symptoms ◽

Initial Learning ◽

Surgeon Experience ◽

Open Pyeloplasty

Introduction Robotic-assisted laparoscopic pyeloplasty (RALP), the most commonly undertaken paediatric robotic urologic surgery, has not been compared against open pyeloplasty (OPN) by a single surgeon. Here, we describe our experience and outcomes. Methods Children undergoing RALP or OPN from 2007 to 2013 were reviewed. Clinical success was defined as resolution of presenting symptoms and improved/stable hydronephrosis on ultrasound. Results RALP and OPN cohorts comprised 52 and 40 patients, respectively. RALP patients were significantly older (6.8 vs 1.2 years, p<0.01) and heavier (28.4 vs 8.4 kg, p<0.01). Operative times for RALP were longer (203.3 vs 135.0 min, p<0.01), but decreased significantly with increasing experience (r2=0.42, p<0.01). Seven type-IIIb Clavien–Dindo complications occurred in RALP patients compared with two in OPN cases. There were no differences in postoperative narcotic administration (p=0.92) or duration of stay in hospital (DOSH) (p=0.93). A total of 11/40 (28%) OPN patients required epidural analgesia but none were placed in the RALP cohort. A total of 49/52 (94%) RALP patients and 40/40 OPN cases had successful outcomes. Three RALP patients required revision RALP. Conclusions These data show that outcomes for RALP and OPN were comparable. An initial learning curve with RALP is to be expected, but operative times for RALP approached those for OPN. Previously reported benefits of RALP (reduced analgesic requirements, DOSH) were not observed. This difference may have been due to comparison of a heterogeneous cohort. Close evaluation of complications allowed for improved placement of stents in RALP.

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