Proctor environment facilitates faculty training in pediatric robotic-assisted laparoscopic pyeloplasty

At our institution, faculty surgeons newly practicing robotic surgery are proctored by an expert surgeon for a minimum of three cases before operating independently. Our study evaluates the effectiveness of this proctor environment on the learning curve of faculty pediatric urologists training to perform robotic-assisted laparoscopic (RAL) pyeloplasty. We reviewed all pediatric RAL pyeloplasties performed at our institution between June 2006 and September 2012, comparing procedures performed by expert surgeon (E) and two training surgeons (both previously experienced laparoscopic surgeons). Training surgeons were proctored for at least three cases before able to operate on their own. Learning curve was quantified by benchmarking training surgeons’ post-proctored operative times to E’s mean operative time. One hundred and thirty-four RAL pyeloplasties were performed during the time period. Mean operative time was 3:31 h from start of cystoscopy to dressing placement. Both training surgeons achieved E’s mean operative time by their fourth case. The transition from laparoscopic pyeloplasty to RAL pyeloplasty for faculty surgeons in a proctor environment results in a more rapid achievement of benchmark levels than previously described for a new learner. The dual module da Vinci^® Si surgical system may expedite this process further with the operative surgeon acting as a true “co-pilot”.