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Updated: Apr 28, 2026

Retzius-Sparing Robot-Assisted Radical Prostatectomy
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Developing a robotic prostatectomy service and a robotic fellowship programme - defining the learning curve.

Nikhil Vasdev1, Conrad Bishop1, Atoine Kass-Iliyya1

  • 1Department of UrologyAnaesthetics, Hertfordshire and South Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK.

Current Urology
|June 12, 2014
PubMed
Summary

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Robotic radical prostatectomy (RRP) improves outcomes as surgeons gain experience. This study shows RRP is safe and effective, with better results as the learning curve progresses.

Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Robotic radical prostatectomy (RRP) is a key treatment for prostate cancer in expert centers.
  • Developing an RRP service involves surgeon training and establishing fellowship programs.
  • Assessing the learning curve is crucial for optimizing RRP outcomes.

Purpose of the Study:

  • To evaluate the learning curve of three surgeons performing RRP.
  • To assess the impact of experience on peri-operative and oncological outcomes.
  • To determine the safety and efficacy of RRP during service development.

Main Methods:

  • A retrospective analysis of 300 consecutive RRP cases (Nov 2008 - Aug 2012).
  • Patients were divided into three groups of 100 to track learning curve progression.
Keywords:
Fellowship trainingLearning curveProstate cancerRobotic radical prostatectomy

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  • Peri-operative outcomes (console time, hospital stay) and oncological results (positive surgical margins) were compared.

    • Main Results:

    • Significant reductions in console time, operating time, hospital stay, and catheter duration were observed across the groups.
    • Initial PSA and tumor stage were key predictors of positive surgical margins (PSM).
    • The overall PSM rate was 26.7%, with a reduction in T2/T3 tumors as experience grew; major complications were low (2%).

    Conclusions:

    • RRP is a safe procedure with low morbidity.
    • Surgeon experience on the learning curve directly correlates with improved peri-operative and oncological outcomes.
    • A structured, mentored approach enables safe introduction of RRP without compromising patient outcomes.