Learning Curve of Robotic Assisted Pyeloplasty for Pediatric Urology Fellows

Purpose: Little is known about the learning curve of robotic surgery for surgeons in training. We hypothesized that pediatric urology fellows could attain proficiency in robotic pyeloplasty, defined as operative time equivalent to that of an experienced robotic surgeon, within the 2-year time frame of fellowship. Materials and Methods: From 2006 to 2010 we performed a prospective cohort study of pediatric robotic pyeloplasty done by 4 pediatric urology fellows and 1 pediatric urology attending surgeon. We recorded operative times and surgical outcomes of the total of 20 consecutive robotic pyeloplasties performed by the 4 pediatric urology fellows (80 cases) and a random sample of 20 performed by the attending surgeon. Multivariate linear regression was used to determine the change in operative time for each case done by fellows and estimate the number of cases needed for fellows to achieve the median operative time of the attending pediatric urologist. Results: Fellow operative time decreased at a constant average rate of 3.7 minutes per case (95% CI 3.0-4.3). Fellows were projected to achieve the median operative time of the attending surgeon after 37 cases. No operative complications or failed pyeloplasties occurred. Conclusions: The operative time for robotic pyeloplasty performed by fellows consistently decreased with cumulative surgical experience. These data can be used to help establish benchmarks of robotic pyeloplasty for pediatric urology, assuming appropriate exposure to robotics and adequate case volume.