ArticleInternational urology and nephrology2022
Attaining competency and proficiency in open pyeloplasty: a learning curve configuration using cumulative sum analysis.
Article in International urology and nephrology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 4 citations in OpenAlex.
- Learning curve for second-stage laparoscopic Fowler-Stephens orchidopexy: an exploratory CUSUM analysis with prospective ultrasonographic follow-up.World journal of urology · 2026Article
- Enhancing outcomes and accelerating learning curves in open pyeloplasty.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2026Article
- Attaining competency and proficiency in pediatric robot-assisted laparoscopic ureteric reimplantation: a learning curve configuration using cumulative sum analysis.World journal of urology · 2025Article
- Evaluating the trainee impact on robotic surgery learning curves: a CUSUM analysis of large series pediatric robot-assisted laparoscopic pyeloplasty.Journal of robotic surgery · 2025Article
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe learning curves for minimally invasive pyeloplasty techniques have been described in the past. However, the learning curve in achieving competency in open pyeloplasty has not been described. Hence, we aim to evaluate a single surgeon series of open pyeloplasty technique using the cumulative sum (CUSUM) methodology.
methodsWe retrospectively reviewed all open pyeloplasties performed by a single surgeon (AJL) between January 2008 and March 2020. Collected variables included: sex, age at surgery, operative time, hospital stay, pre-operative ultrasound, pre-operative nuclear scans, pre-operative anteroposterior diameter, associated anomalies, laterality (left or right), type of stent, pre-operative split renal function, and duration of follow-up. A CUSUM analysis was used: the highest peak, plateau and downward trends for complications (defined as Clavien-Dindo classification ≥ 3b) were identified on the plot and set as the transition points between five phases (learning, competency, proficiency, case-mix, and mastery).
resultsBased on the CUSUM analysis, the index surgeon reached the competency phase after performing their 13th open pyeloplasty and became proficient after the 70th case. In the case-mix phase (104th-126th cases), where the surgeon may be performing more complex cases while increasing trainee involvement, there was a slight increase in complication rates. After the 126th case, the surgeon entered the mastery phase, where there was consistent decreasing trend in complications.
conclusionsSurgeons performing open pyeloplasty in children following completion of their surgical training will continue to learn through their early cases until achieving competency. Technical competency may be reached after the 13th case. In this report, we looked at the number of cases to become proficient in open pyeloplasty procedure in children. A surgeon may achieve technical proficiency in the procedure after their 13th case.
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