Learning curve for single-surgeon robot-assisted single-port extraperitoneal radical prostatectomy

Abstract

To evaluate surgical outcomes of robot-assisted single-port extraperitoneal radical prostatectomy (E-sp-RALP) performed by a single surgeon and to characterize the procedural learning curve. Clinical data from 50 consecutive E-sp-RALP procedures performed at the Affiliated Hospital of Nanjing University of Chinese Medicine between January and December 2020 were retrospectively analyzed. A cumulative sum (CUSUM) learning curve analysis was performed with the total operation time as the study outcome. CUSUM analysis identified case 11 as the inflection point of the learning curve, and procedures were subsequently stratified into an initial learning phase (cases 1–11) and a subsequent phase (cases 12–50). Operation time decreased significantly from 130.00 min (IQR, 117.50–155.00) in the initial phase to 115.00 min (IQR, 95.00–120.00) in the subsequent phase ( P < 0.05). Similarly, robot console time was significantly reduced from 105 min (IQR, 90–125) to 85 min (IQR, 72.5–100) ( P < 0.05). No significant differences were observed in blood loss, drainage tube indwelling time, postoperative hospital stay, or complication rates (all P > 0.05). Furthermore, no differences were found between the two phases regarding positive surgical margins, biochemical recurrence, continence recovery, or time to continence recovery (all P > 0.05). These findings indicate that proficiency in E-sp-RALP was associated with improved operative efficiency after approximately 11 cases, while maintaining comparable perioperative safety and early oncological and functional outcomes. E-sp-RALP demonstrates a measurable learning curve, with the major initial technical adaptation occurring within approximately the first 11 cases. Operative efficiency continued to improve with increasing experience, while perioperative safety and early oncological and functional outcomes remained stable.