ESPU Congress 2018 - Abstract Book

117

11–14 APRIL, 2018, HELSINKI, FINLAND

09:01–09:04

S14-4 (PP)

LEARNING CURVE OF PEDIATRIC SURGERY USING

VESICOSCOPIC ACCESS

Aleksandr PIROGOV

, Vladimir SIZONOV

and Mikhail KOGAN

1) Children's Clinical Hospital of the Astrakhan Province, Paediatric Urology, Astrakhan, RUSSIAN FEDERATION -

2) Regional Children's Hospital, Paediatric Urology, Rostov On Don, RUSSIAN FEDERATION - 3) The Rostov State

Medical University, Urology, Rostov On Don, RUSSIAN FEDERATION

PURPOSE

The learning rate of surgical interventions used in cases of bladder and ureterovesical junction

diseases in children and based on vesicoscopic access (VA) remains understudied. We analyzed

the learning curve based on the experience of 157 vesicoscopic surgeries performed by a single

surgeon (P.A.V.).

MATERIAL AND METHODS

From 2012 through 2017, VA was used in surgical treatment of 157 patients ranging in age from

2 months to 18 years (average age 4.9±8.7 years) – 79 girls and 78 boys. 110 patients (70.0 %)

had unilateral ureteroneocystostomy carried out using vesicoscopic access: (21 (18.2 %) cases

– ureterovesical junction (UVJ) obstruction, 89 (81.8 %) – vesicoureteral reflux (VUR). 44 patients

(28.0 %) had bilateral ureteroneocystostomy performed using vesicoscopic route (VUR – 43 pa-

tients (97.7 %), 1 (2.3 %) – UVJ obstruction), 3 children (1.9 %) – diverticulectomy. To determine

the learning curve, we fitted a nonlinear regression of a point set with every point representing the

duration of a unilateral ureteral reimplantation for VUR correction.

RESULTS

It was established that the learning plateau (the shortest possible surgery duration) was 82 minutes.

According to our data, the surgeon needed to carry out 25 unilateral anti-reflux surgeries to reach

the 90 % potential (reflecting the corresponding learning rate). In addition, by the time when 25 uni-

lateral anti-reflux interventions were performed, 69 children had been operated using VA.

CONCLUSIONS

A large number of VAoperations necessary to develop manual skills to an optimal level demonstrates

the complexity of vesicoscopic surgery and determines the need for a certain dedication to learning

of the technique. However, the attainable reduction of surgery duration to values comparable with

open surgery combined with its less traumatic character completely justifies the efforts invested in

mastering the procedure.