Robotic surgery start-up with a fellow as the console surgeon

Objective: Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume. Materials and methods: The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site. Results: The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182min and was significantly shorter than in laparoscopic surgery (median 250min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1day) than after both laparoscopic (median 2days) and open surgery (median 3.5days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6weeks. Conclusions: The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.