Enhancing outcomes and accelerating learning curves in open pyeloplasty

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Introduction: We aimed to evaluate the impact of surgical mentorship on case outcomes and learning curves of early-career surgeons performing pediatric open pyeloplasty. Methods: Using an institutionally maintained prospective case log, we retrospectively analyzed all open pyeloplasty cases consecutively performed by an index junior academic surgeon under the mentorship of a senior surgeon between April 2020 and May 2023. The mentor was available for all cases and scrubbed in for early cases, with decreasing direct involvement over time. The data collected included case characteristics, operative times, followup durations, and surgical complications within a two-year postoperative period. A cumulative sum (CUSUM) analysis was employed to identify peaks, plateaus, and trends for complications (defined as Clavien-Dindo classification ≥3b) and operative time. Results: We analyzed 54 open pyeloplasty cases performed under surgical mentorship and categorized them into four phases using CUSUM analysis. Based on this, the junior surgeon reached the competency-proficiency phase between the 12th and 26th case, demonstrating consistent technical skill development, reduced operative times, and satisfactory outcomes under mentorship. In the case-mix phase (45th-54th case), a slight increase in operative time was noted, coinciding with more complex cases and increased trainee involvement. Conclusions: This analysis demonstrated that surgical mentorship for junior academic surgeons facilitates early technical proficiency in pediatric open pyeloplasty, enabling them to safely achieve comparable outcomes early in their careers. These findings suggest that mentorship is key to ensuring satisfactory surgical outcomes during the initial stages of a surgeon’s learning curve.

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