The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach.

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.