Analysis of the learning curve for Retzius-sparing Robot-assisted radical prostatectomy for a single surgeon

Abstract

Introduction: The learning curve for retzius sparing robotic radical prostatectomy is not fully understood. This study attempts to identify the learning-curve across the first 130 cases of a single surgeon. Methods: All retzius sparing robotic radical prostatectomy cases performed by a single surgeon between April 2019 and July 2022 were included. Cases were divided chronologically into 3 groups. Results: 130 RS-RARP cases were identified. Statistically significant differences were found between groups in several areas. Median patient age increased between group 1 (59yrs) and Group 3 (66.5yrs) (P=0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) (P=0.036). Median console time increased between Group 1 (120 mins) and Group 2 (150 mins,) (P=0.01). Median gland weight increased between Group 1 (28g) and Group 3 (35.5g) (P<0.001). Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Conclusions: The complexity of cases increased over the learning curve, reflected in older patients, larger prostates and higher stage disease, but the positive surgical margin rate improved with experience. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease.