Quantifying the Learning Curve in Robotic Peritoneal Flap Vaginoplasty

Area of Science:

• Robotic Surgery
• Gender-Affirming Care
• Surgical Education

Background:

• The learning curve (LC) quantifies the mastery of new surgical techniques.
• Robotic-assisted peritoneal flap gender-affirming vaginoplasty (RPGAV) is an evolving procedure.
• Assessing the LC for RPGAV is crucial for optimizing surgical training and patient outcomes.

Purpose of the Study:

• To evaluate the learning curve for robotic-assisted peritoneal flap gender-affirming vaginoplasty (RPGAV).
• To identify factors influencing operative time (OT) during RPGAV.
• To compare outcomes between the learning and expert phases of RPGAV.

Main Methods:

• Retrospective chart review of 500 consecutive RPGAV cases (09/2017-02/2023).
• Analysis of operative times (OT) to determine the learning curve plateau.
• Comparison of perioperative and postoperative outcomes between early and late phases of the learning curve.

Main Results:

• The learning curve for RPGAV was determined to be 300 cases, after which operative times stabilized.
• Increased body mass index significantly increased OT, while single-port robotic systems decreased OT.
• The expert phase (last 200 cases) demonstrated reduced length of stay, fewer blood transfusions, and lower rates of revision surgery compared to the learning phase (first 300 cases).

Conclusions:

• A cohort of 300 cases is required to achieve proficiency in robotic-assisted peritoneal flap gender-affirming vaginoplasty.
• Patient BMI and robotic system type (single-port vs. multiport) are significant determinants of operative time.
• Surgical experience in RPGAV leads to demonstrable improvements in clinical efficiency and patient outcomes.