The learning curve for robotic-assisted pyeloplasty in children: Our initial experience from a single center
Noor Nabi Junejo1, Anwar Alotaibi2, Saeed Malwi Alshahrani3, Ahmad Alshammari4, Craig A Peters5, Hamdan Alhazmi6, Santiago A Vallasciani7
1 Urology Department, King Faisal Specialist Hospital and Research Centre and College of Medicine, Alfaisal University; Pediatric Urology Division, Urology Department, King Faisal Specialist Hospital and Research Centre, Abha, Saudi Arabia
2 Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Abha, Saudi Arabia
3 King Faisal Medical City for Southern Region, Abha, Saudi Arabia
4 Pediatric Urology Division, Urology Department, King Faisal Specialist Hospital and Research Centre, Abha; Pediatric Urology Division, Department of Surgery, King Abdullah Specialized Children Hospital, National Guard Health Affair, Riyadh, Saudi Arabia
5 Children's Medical Centre, University of South-Eastern, Dallas, Texas, USA
6 Urology Division, Department of Surgery, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
7 Pediatric Urology Division, Surgery Department, Sidra Medical and Research Center, Doha, Qatar
Dr. Noor Nabi Junejo
Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh
Background: Robotic-assisted pyeloplasty surgery has become the preferred approach of ureteropelvic junction obstruction (UPJO) in pediatrics. However, to our knowledge, there is limited data on the learning curve for robotic-assisted pyeloplasty in children and no similar study from Saudi Arabia.
Aims: The objective of the study was to evaluate the progression of the surgical team performing robotic-assisted laparoscopic pyeloplasty (RALP) and to assess the feasibility of the RALP in children, since it is having been recently started in the Kingdom.
Settings and Design: Retrospective charts and surgical videos review at the tertiary care centre.
Subjects and Methods: After approval from the internal review board (IRB), we reviewed the surgical video recording of the RALP procedure of 15 patients presented with UPJO from January 2016 to October 2017. Statistical analysis was done for the variables includes dissection time, pyelotomy, anastomosis on both sides, and total surgery time and calculated in minutes. Renal ultrasound reviewed to assess any change in grade.
Results: Fifteen patients with UPJO underwent RALP. Of 15 cases, nine were primary and six cases as secondary UPJO. The median age was 8 (3–15) years. Out of 15 cases, 13 and 2 patients diagnosed as Society for Fetal Urology grades of 4 and 3, respectively. Total operative time was prolonged in secondary group as compared to primary pyeloplasty group (mean [standard deviation (SD)]: 166.3 [35.1], range: 125–223, P = 0.0028 versus mean (SD): 149.17 (30.4), range: (114–207), P = 0.0008). The success rate was 100% in primary and 84% in secondary cases. The median length of follow-up was 12.0 (7.0–18.0) and 10.0 (8.0–12.5) months in primary and secondary cases, respectively. The overall complication rate was 13% (2/15) (Clavien grade: 1–2).
Conclusions: The evaluation of the learning curve of RALP for this group of patients concluded that total operative time for RALP, performed by the pediatric urology team, steadily decreased with collective surgical experience.