The Learning Curve Does Not Affect Positive Surgical Margin Status in Robot-Assisted Laparoscopic Prostatectomy.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted laparoscopic prostatectomy (RALP) is a common procedure for prostate cancer.
• Understanding the learning curve (LC) is crucial for optimizing surgical outcomes and patient safety.

Purpose of the Study:

• To evaluate the oncologic outcomes of RALP.
• To determine the impact of the surgeon's learning curve on oncological results.

Main Methods:

• 111 patients underwent RALP by a single surgeon.
• Learning curve analyzed using the moving average method, classifying patients into two groups (1-50 and 51-111 cases).
• Compared positive surgical margins (PSM), extracapsular invasion (ECI), operation times, hospitalization duration, and complications (Clavien system).

Main Results:

• The learning curve stabilized between cases 51-60.
• Positive surgical margin rates decreased from 36% (Group 1) to 18% (Group 2) (p=0.032).
• Extracapsular invasion was significantly higher in Group 1 (56.5%) vs. Group 2 (29.5%) (p=0.005). Operation time and hospitalization duration were reduced post-LC.
• 10% of patients experienced complications, with 0.9% requiring surgical intervention.

Conclusions:

• At least 50 RALP cases are necessary for experienced surgeons to achieve proficiency.
• Surgeon experience influences perioperative variables but not positive surgical margin status in RALP.
• RALP demonstrates favorable oncologic outcomes and a manageable learning curve.