title: Robot-assisted pyeloplasty: follow-up of first Canadian experience with comparison of outcomes between experienced and trainee surgeons.
abstract: OBJECTIVE
  Robot-assisted pyeloplasty (RAP) has been established recently as an option in the management of ureteropelvic junction obstruction (UPJO). We present the first Canadian experience with RAP with respect to operative results and outcomes. We compare the surgical outcomes between experienced and trainee surgeons, with respect to operating room times and success rates.
  
  
  METHODS
  Eighty-eight patients underwent transperitoneal RAP for UPJO using the da Vinci robotic platform. Two surgeons performed Anderson-Hynes dismembered pyeloplasty in 85 cases and YV-plasty in 5 cases. Five patients had RAP for secondary UPJO after failure of other treatments. Diuretic renography was performed at 6 weeks, and 6, 12, 18, 24, and 36 months postpyeloplasty. The mean follow-up was 14.1 ± 8.5 months.
  
  
  RESULTS
  The mean operative time was 167.7 ± 43.2 minutes, and the mean anastomotic time was 41.9 ± 14.1 minutes. The mean operative duration significantly decreased with time (P < 0.05). Ten patients needed simultaneous nephroscopic stone management via the pyelotomy incision. The mean blood loss was 56.6 ± 55.4 mL, and the mean hospital stay was 2.5 ± 0.5 days. There were five major postoperative (stent migration, urinoma) and three minor complications that were associated with the RAP procedures. Postoperative renal scintigraphy demonstrated only four cases with persistent obstruction. Eighty-three (94.3%) patients experienced improvement of symptoms whereas 5 continued to be symptomatic. Two patients needed secondary procedures to relieve persisting obstruction. There were no statistical differences in outcomes between the experienced surgeons and trainees (P = 0.28).
  
  
  CONCLUSIONS
  In the first large case series of RAP from Canada, we demonstrate that RAP can be performed with relatively short operative times and is safe and effective, achieving similar long-term results with standard open repair. We show that robot-assisted surgery can be safely transitioned to surgical trainees. With its cost and availability, its role in the Canadian system needs further study.
authors.affiliation: Division of Urology, Department of Surgery, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Petar
authors.initials: P
authors.lastname: Erdeljan
authors.forename: Yves
authors.initials: Y
authors.lastname: Caumartin
authors.forename: Jeff
authors.initials: J
authors.lastname: Warren
authors.forename: Christopher
authors.initials: C
authors.lastname: Nguan
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.forename: Patrick P W
authors.initials: PP
authors.lastname: Luke
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
mesh_terms: D002170:Canada; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D019651:Plastic Surgery Procedures / Q000193:education* / Q000379:methods*; D012371:Robotics / Q000193:education* / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome