Original Papers - Prostate Open access

Impact of laparoscopic experience on learning curves in robotic-assisted radical prostatectomy: a comparative analysis of oncological and functional outcomes

Authors

Published
26 May 2025
Section
Original Papers - Prostate
DOI
10.4081/aiua.2025.13640

Abstract

Objective: This study aimed to evaluate the influence of prior laparoscopic experience on the learning curve and surgical outcomes of robotic-assisted radical prostatectomy (RaRP).
Methods: A retrospective analysis was performed on 101 patients treated between 2021 and 2023. Two surgeons at the beginning of their robotic learning curves were compared: one with extensive prior laparoscopic experience and the other without such a background. Perioperative, oncological, and functional outcomes were assessed, with a specific focus on Pentafecta criteria. Statistical analyses and cumulative sum (CUSUM) charts were employed to evaluate performance trends and surgical outcomes.
Results: Surgeon A, with substantial prior laparoscopic expertise, demonstrated shorter operative times (p = 0.015), reduced intraoperative blood loss, and superior early functional outcomes. Specifically, patients operated on by Surgeon A exhibited higher pad-free continence rates and improved erectile function recovery at 12 months postoperatively (p < 0.01). Additionally, nerve-sparing procedures performed by Surgeon A showed a trend toward fewer positive surgical margins, although this difference did not reach statistical significance. CUSUM analysis revealed more stable and consistent performance trends for Surgeon A in achieving Pentafecta outcomes compared to Surgeon B.
Conclusions: Previous laparoscopic experience significantly contributes to shortening the learning curve for RaRP and enhancing early functional outcomes. This advantage is likely attributable to greater surgical anatomical knowledge. These findings highlight the importance of tailored training programs and the potential for skill transfer between laparoscopic and robotic approaches. Further studies are warranted to refine surgical education strategies and improve patient care outcomes.

Keywords

References

  1. Philippou P, Waine E, Rowe E. Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. J Endourol. 2012; 26:1002-8. DOI: https://doi.org/10.1089/end.2011.0569
  2. Goonewardene SS, Cahill D. The Da Vinci Xi and robotic radical prostatectomy-an evolution in learning and technique. J Robot Surg. 2017;11:111-3. DOI: https://doi.org/10.1007/s11701-016-0620-x
  3. Grossi FS, Utano E, Minafra P, et al. Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience. Arch Ital Urol Androl. 2021;93:268-273. DOI: https://doi.org/10.4081/aiua.2021.3.268
  4. Geraghty K, Keane K, Davis N. Systematic review on urinary continence rates after robot-assisted laparoscopic radical prostatectomy. Ir J Med Sci. 2024; 193:1603-1612. DOI: https://doi.org/10.1007/s11845-023-03603-3
  5. Kim DK, Moon YJ, Chung DY, et al. Korean Society of Endourology and Robotics (KSER) Research Committee. Comparison of robot-assisted, laparoscopic, and open radical prostatectomy outcomes: a systematic review and network meta-analysis from KSER update series. Medicina (Kaunas). 2025; 61:61. DOI: https://doi.org/10.3390/medicina61010061
  6. Salciccia S, Santarelli V, Di Pierro GB, et al. Real-life comparative analysis of robotic-assisted versus laparoscopic radical prostatectomy in a single centre experience. Cancers (Basel). 2024;16:3604. DOI: https://doi.org/10.3390/cancers16213604
  7. Shikanov SA, Zorn KC, Zagaja GP, Shalhav AL. Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology. 2009;74:619-23. DOI: https://doi.org/10.1016/j.urology.2009.02.082
  8. Carlos AF, Dario VM, Popescu RI, et al. Robot-assisted radical prostatectomy (RARP) trifecta learning curve for surgeons with previous experience in laparoscopy. Medicina (Kaunas). 2024;60:1032. DOI: https://doi.org/10.3390/medicina60071032
  9. Costa Moretti TB, Oliveira Reis L, Maes KK. Comparative analysis of perioperative outcomes in radical prostatectomy: laparoscopic versus robot-assisted techniques. Uro-Technol J. 2024; 8:65-72. DOI: https://doi.org/10.31491/UTJ.2024.12.026
  10. Prontera PP, Prusciano FR, Lattarulo M, et al. Quality of bladder cancer treatment information on YouTube: May the user's profile affect the quality of results? Arch Ital Urol Androl. 2024;96:12179. DOI: https://doi.org/10.4081/aiua.2024.12179
  11. Monnerat Lott F, Siqueira D, Argolo H, et al. Analysis of the learning curve of surgeons without previous experience in laparoscopy to perform robot-assisted radical prostatectomy. Adv Urol. 2018; 2018: 9073807. DOI: https://doi.org/10.1155/2018/9073807
  12. Machado MT, Mitre AI, Rubinstein M et al. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist? Int Braz J Urol. 2016;42:83-9. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2014.0485
  13. Savage CJ, Vickers AJ. Low annual caseloads in US surgeons conducting radical prostatectomy. J Urol. 2009;182:2677-9. DOI: https://doi.org/10.1016/j.juro.2009.08.034
  14. D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969. DOI: https://doi.org/10.1001/jama.280.11.969
  15. Adili AF, Di Giovanni J, Kolesar E, et al. Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon. Can Urol Assoc J 2017; 11:E409-13. DOI: https://doi.org/10.5489/cuaj.4588
  16. Good DW, Stewart GD, Laird A, et al. A critical analysis of the learning curve and postlearning curve outcomes of two experience- and volume-matched surgeons for laparoscopic and robot-assisted radical prostatectomy. J Endourol. 2015; 29:939-47. DOI: https://doi.org/10.1089/end.2014.0810
  17. Ku JY, Ha HK. learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy. World J Mens Health 2015; 33:30-35. DOI: https://doi.org/10.5534/wjmh.2015.33.1.30
  18. Lin PL, Zheng F, Shin M, et al. CUSUM learning curves: what they can and can't tell us. Surg Endosc. 2023; 37:7991-7999. DOI: https://doi.org/10.1007/s00464-023-10252-1
  19. Grossi FS, Di Lena S, Barnaba D, et al. Laparoscopic versus open radical retropubic prostatectomy: a case-control study at a single institution. Arch Ital Urol Androl. 2010; 82:109-12.

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2025 the Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.