title: Robotic surgery start-up with a fellow as the console surgeon.
abstract: OBJECTIVE
  Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume.
  
  
  METHODS
  The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5 year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site.
  
  
  RESULTS
  The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182 min and was significantly shorter than in laparoscopic surgery (median 250 min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1 day) than after both laparoscopic (median 2 days) and open surgery (median 3.5 days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6 weeks.
  
  
  CONCLUSIONS
  The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.
authors.affiliation: a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Reinhardt
authors.affiliation: a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Inge Boetker
authors.initials: IB
authors.lastname: Ifaoui
authors.affiliation: a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark.|b Faculty of Medical and Health Sciences , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Thorup
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005240:Feasibility Studies; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D061646:Operative Time; D010372:Pediatrics; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000193:education / Q000379:methods*
keywords: Children; minimally invasive; pyeloplasty; robotic urological surgical procedures; surgical training