This article provides a detailed analysis of learning curve aspects of retrograde intrarenal surgery (RIRS) in urology residents.

We prospectively reviewed the cases of flexible ureterorenoscopy with laser lithotripsy between January 2024 and November 2024. We divided surgeons to 3 groups: residents with learned basic skills and no real-life surgery experience (Group 1), residents with experience up to 20 self-performed surgeries (Group 2) and endourologists with experience more than 100 self-performed surgeries (Group 3). Usually the residents start to perform this surgery on the 3rd year of residence.

Time to insert the access sheath, fluoroscopy time, and the whole operation time were the highest in Group 1 and shorter in Group 2 and 3 (p < 0.01). The necessary for additional treatment due to complications and, consequently, postoperative length of stay were found to be minimal in Group 2 (p < 0.01), and the stone-free rate (SFR) higher and similar in Group 2 and 3 (p < 0.05) than Group 1. The highest complication rates were observed in Group 1 (p = 0.05). In time SFR rate increased with the number of performed surgeries. Success was stable after 19-23 cases in terms of SFR. In limitation, every resident performs their first 10 cases under the supervision of experienced endourologist, and, if it necessary, they have an option to ask for help as a part of the education program.

In time, access time and fluoroscopy time and risk of complications decrease and SFR increase with gaining new experience. The SFR is significantly higher after 19-23 cases and accessible in group of residents.