Kim Jin Kyu, Batra Nik, Shavnore Renee, Szymanski Konrad M, Misseri Rosalia, Kaefer Martin, Cain Mark P, Roth Joshua, Dangle Pankaj, Meldrum Kirstan, Rink Richard C, Whittam Benjamin
Department of Pediatric Urology, Riley Hospital for Children, Indiana University Health, 702 Barnhill Drive, Indianapolis, IN, 46202, USA.
World J Urol. 2025 Jun 14;43(1):372. doi: 10.1007/s00345-025-05658-6.
Robot-assisted laparoscopic ureteric reimplantation (RALUR) is a minimally invasive procedure for treating vesicoureteral reflux (VUR) and congenital megaureter. Despite its benefits, the adoption of RALUR involves a significant learning curve. This study aims to evaluate the learning curve of a fellowship-trained surgeon performing RALUR using cumulative sum (CUSUM) analysis.
A retrospective review of RALUR cases without concurrent procedures from July 2012 to July 2024 was conducted. Patients' clinical characteristics and surgical outcomes were assessed. The learning curve was analyzed using CUSUM for operative time (OT) and complication rates (CR), dividing the curve into three phases: learning (phase 1), competency (phase 2), and proficiency (phase 3).
There was a total of 65 eligible RALUR cases within specified time-period (38 bilateral). There was an overall median follow up of 16.8 months (IQR 8.2-39.4). The overall reoperation rates were 6.2% (4/65). CUSUM-OT peaked at case 23, indicating the end of the learning phase, and progression to competency (phase 2). By case 40, the surgeon achieved proficiency, with continued improvement in CUSUM-CR. Increased case complexity and trainee involvement in phase 3 did not adversely affect patient outcomes. Mention traditional OT analysis finding.
The learning curve for RALUR can be effectively mapped using CUSUM analysis, with technical competency reached by the 24th case. Patient safety was not compromised during the learning process of trainees. Future research should include multi-institutional studies and simulation-based training to generalize findings and enhance surgical training programs.
机器人辅助腹腔镜输尿管再植术（RALUR）是治疗膀胱输尿管反流（VUR）和先天性巨输尿管的一种微创手术。尽管有诸多益处，但采用RALUR存在显著的学习曲线。本研究旨在使用累积和（CUSUM）分析评估接受专科培训的外科医生进行RALUR的学习曲线。
对2012年7月至2024年7月期间未同时进行其他手术的RALUR病例进行回顾性研究。评估患者的临床特征和手术结果。使用CUSUM分析手术时间（OT）和并发症发生率（CR）的学习曲线，将曲线分为三个阶段：学习阶段（第1阶段）、胜任阶段（第2阶段）和熟练阶段（第3阶段）。
在指定时间段内共有65例符合条件的RALUR病例（38例双侧）。总体中位随访时间为16.8个月（四分位间距8.2 - 39.4）。总体再次手术率为6.2%（4/65）。CUSUM - OT在第23例时达到峰值，表明学习阶段结束，进入胜任阶段（第2阶段）。到第40例时，外科医生达到熟练水平，CUSUM - CR持续改善。第3阶段病例复杂性增加和有实习医生参与并未对患者结局产生不利影响。提及传统OT分析结果。
使用CUSUM分析可以有效地描绘RALUR的学习曲线，第24例时达到技术胜任。在实习医生的学习过程中患者安全未受影响。未来研究应包括多机构研究和基于模拟的培训，以推广研究结果并加强手术培训项目。
