Purpose <p>Pediatric robotic-assisted pyeloplasty is commonly performed in pediatric urology. The ureteral stent insertion step at the time of ureteral dismemberment was recognized as requiring effective coordination of skillsets among the console surgeon, bedside assistant, surgical technologist and circulating nurse. The goals of this study were to create a workflow for developing a surgical simulation intervention based on a specific clinical goal and to assess its impact on the time needed for ureteral stent insertion in the clinical setting.</p> Materials and methods <p>The simulation session incorporated team-based training elements including post-event facilitator-guided debriefing, as well as within-team brainstorming and problem solving. During the simulation intervention, the procedural approach was refined with each iteration. The time required to complete the ureteral stent insertion step in the clinical setting was evaluated both pre- and post-simulation intervention.</p> Results <p>Following the simulation intervention, several procedural changes were implemented in the clinical setting. These included using an objective guide for the amount of wire inserted, clarifying the roles of the bedside assistant and surgical technologist, and introducing a reference chart to determine ureteral stent length based on age. A surgical warm-up video was created for team review prior to surgery. The average time for stent insertion decreased from 14&#xa0;min pre-simulation to 8&#xa0;min post-simulation (not statistically significant).</p> Conclusions <p>Our approach to improving operating room efficiency utilized a simulation workflow with debrief structure that incorporated problem solving, resulting in procedural changes. This approach demonstrated trends toward improved efficiency for ureteral stent insertion during robotic-assisted pyeloplasty.</p>