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Updated: May 17, 2025

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Learning Curve of Single-Port Robotic-Assisted Extraperitoneal Radical Prostatectomy: A CUSUM-Based Analysis.

Valerio Santarelli1,2, Fabio Maria Valenzi2,3, Muhannad Aljoulani2,4

  • 1Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|May 15, 2025
PubMed
Summary

The learning curve for single-port robotic-assisted radical prostatectomy (SP-RARP) is comparable to multi-port techniques. Proficiency is achieved efficiently, maintaining safety and oncological outcomes.

Keywords:
cumulative sum (CUSUM)learning curveprostate cancerradical prostatectomyrobotic-assisted surgerysingle port

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Single-port robotic-assisted radical prostatectomy (SP-RARP) is a feasible and safe procedure.
  • Skill transfer from multi-port (MP) surgery to SP surgery presents challenges.
  • Assessing the learning curve is crucial for SP-RARP adoption.

Purpose of the Study:

  • To evaluate the learning curve associated with SP-RARP.
  • To determine the number of cases required to achieve proficiency in SP-RARP.
  • To compare perioperative and postoperative outcomes between learning and proficiency phases.

Main Methods:

  • Analysis of 119 extraperitoneal SP-RARPs (83 with pelvic lymphadenectomy [PLND], 36 without).
  • Risk-adjusted cumulative summation (CUSUM) methodology to assess operative time.
  • Cubic polynomial regression to plot learning curves and identify inflection points.

Main Results:

  • Proficiency in SP-RARP was achieved by the 42nd case (with PLND) and 20th case (without PLND).
  • Proficiency phase cases showed significantly shorter operative times and hospital stays.
  • SP-RARP without PLND in the proficiency phase had lower postoperative pain scores.

Conclusions:

  • The learning curve for extraperitoneal SP-RARP is not longer than for MP-RARP.
  • SP-RARP can be learned without compromising safety or oncological outcomes.
  • Careful approach to learning SP-RARP ensures successful outcomes.