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  1 , Vladimir SIZONOV  2 and Mikhail KOGAN  3 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.