Attaining competency and proficiency in open pyeloplasty: a learning curve configuration using cumulative sum...

Area of Science:

• Pediatric Urology
• Surgical Education
• Minimally Invasive Surgery

Background:

• Learning curves for minimally invasive pyeloplasty are established.
• The learning curve for open pyeloplasty has not been previously described.
• This study addresses this gap by evaluating open pyeloplasty learning curves.

Purpose of the Study:

• To evaluate the learning curve for open pyeloplasty in a single surgeon series.
• To define phases of surgical learning using cumulative sum (CUSUM) methodology.
• To identify the number of cases required to achieve competency and proficiency.

Main Methods:

• Retrospective review of open pyeloplasties performed by a single surgeon (AJL) from 2008-2020.
• Data collection included patient demographics, operative details, and outcomes.
• Cumulative Sum (CUSUM) analysis was employed to assess complication trends and define learning phases.

Main Results:

• Competency in open pyeloplasty was achieved after the 13th case.
• Proficiency was reached after the 70th case.
• A slight increase in complications occurred during the case-mix phase (104th-126th cases), followed by a decreasing trend in the mastery phase (>126 cases).

Conclusions:

• Surgeons continue to learn and improve through early cases after training.
• Technical competency in open pyeloplasty can be achieved around the 13th case.
• This study provides benchmarks for open pyeloplasty proficiency in pediatric cases.