Retzius-sparing robot-assisted radical prostatectomy: early learning curve experience in three continents

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Retzius-sparing robot-assisted radical prostatectomy (RsRARP) is a novel surgical approach.
• Understanding the learning curve is crucial for optimizing outcomes.

Purpose of the Study:

• To assess the impact of surgical experience on peri-operative, functional, and oncological outcomes during the initial learning phase of RsRARP.
• To evaluate outcomes during the first 50 cases performed by surgeons new to RsRARP.

Main Methods:

• Retrospective analysis of 626 patients from 12 international centers.
• Surgeons were stratified into initial (≤25 cases) and expert (>25 cases) groups.
• Locally weighted scatterplot smoothing was used to explore the relationship between experience and outcomes.

Main Results:

• Expert surgeons had shorter console times (120 vs. 140 min) and lower complication rates (5.5% vs. 13%).
• Console time, immediate urinary continence, and complication rates showed linear improvement with experience.
• Positive surgical margin rates did not demonstrate a clear improvement within the first 50 cases.

Conclusions:

• Peri-operative outcomes, including console time and complication rates, improve rapidly during the RsRARP learning curve.
• Functional outcomes like immediate urinary continence also show quick improvement.
• Oncological outcomes, specifically positive surgical margins, require further investigation beyond the initial 50 cases.