We have located links that may give you full text access.
The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach.
Journal of Pediatric Urology 2018 December
INTRODUCTION: Few studies have evaluated the learning curve (LC) for robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction in children. It was attempted to assess the LC of this procedure using a multi-outcome approach, accounting for patient complexity.
MATERIAL AND METHODS: Data on the first series of children undergoing RALP between November 2007 and December 2017 at the study institution were prospectively collected. Patient complexity factors and peri-operative data including operative time (OT) were retrospectively analyzed. The LC was analyzed using cumulative sum (CUSUM) methodology for OT and a composite parameter (combination of 3 parameters: OT adjusted for patient complexity factors (AOT), complications, and surgical success).
RESULTS: Two surgeons without any experience in robotic surgery performed 42 consecutive RALP in 41 patients. Median age at surgery was 5 years (6 months-15 years), and mean OT was 200 ± 72.8 min. Cumulative sum chart demonstrated biphasic LC for OT and multiphasic LC for composite factor. Based on the CUSUM analysis for composite outcome, the LC for RALP could be divided into three different phases: phase 1, the learning period (1-12 cases); phase 2, the consolidation period (13-22 cases); and phase 3, representing the period of increased competence (23-39 cases). Interphase comparison showed a significant reduction in OT, length of stay, and postoperative pain (P = 0.0001; P = 0.0076; P = 0.039, respectively) CONCLUSION: Numerous distinctly shaped LCs depending on the outcome measures and well-defined learning phase transition points were demonstrated. Patient complexity factors were accounted for, which can influence surgical outcomes. Because there is no perfect indicator of proficiency, a multi-outcome approach was adopted to provide a comprehensive view of the learning process for RALP. More than 41 cases are needed to achieve mastery.
MATERIAL AND METHODS: Data on the first series of children undergoing RALP between November 2007 and December 2017 at the study institution were prospectively collected. Patient complexity factors and peri-operative data including operative time (OT) were retrospectively analyzed. The LC was analyzed using cumulative sum (CUSUM) methodology for OT and a composite parameter (combination of 3 parameters: OT adjusted for patient complexity factors (AOT), complications, and surgical success).
RESULTS: Two surgeons without any experience in robotic surgery performed 42 consecutive RALP in 41 patients. Median age at surgery was 5 years (6 months-15 years), and mean OT was 200 ± 72.8 min. Cumulative sum chart demonstrated biphasic LC for OT and multiphasic LC for composite factor. Based on the CUSUM analysis for composite outcome, the LC for RALP could be divided into three different phases: phase 1, the learning period (1-12 cases); phase 2, the consolidation period (13-22 cases); and phase 3, representing the period of increased competence (23-39 cases). Interphase comparison showed a significant reduction in OT, length of stay, and postoperative pain (P = 0.0001; P = 0.0076; P = 0.039, respectively) CONCLUSION: Numerous distinctly shaped LCs depending on the outcome measures and well-defined learning phase transition points were demonstrated. Patient complexity factors were accounted for, which can influence surgical outcomes. Because there is no perfect indicator of proficiency, a multi-outcome approach was adopted to provide a comprehensive view of the learning process for RALP. More than 41 cases are needed to achieve mastery.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app