324 the Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review

Aim Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. Method In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines. Results Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS. Conclusions Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.