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Updated: Jan 14, 2026
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Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
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Evaluating the learning curve for single-port radical prostatectomy: a multi-institutional cohort analysis
Alessio Finocchiaro1,2, Nicolò Buffi2,3, Muhannad Aljoulani2,4
1Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
World Journal of Urology
|October 22, 2025
Summary
This multicenter study identified proficiency milestones for single-port robot-assisted radical prostatectomy (SP-RARP). The extraperitoneal approach showed clear learning curves, unlike the transperitoneal approach.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Robotics
Background:
- Single-port robot-assisted radical prostatectomy (SP-RARP) is an advanced minimally invasive technique with unique surgical challenges.
- Existing learning curve data for SP-RARP is limited, primarily from single-center or single-surgeon studies.
- Establishing proficiency benchmarks is crucial for widespread adoption and consistent surgical outcomes.
Purpose of the Study:
- To define objective proficiency milestones for SP-RARP across multiple surgeons and institutions.
- To analyze the learning curves for operative time (OT) and estimated blood loss (EBL) in SP-RARP.
- To compare learning dynamics between transperitoneal (TP) and extraperitoneal (EP) approaches to SP-RARP.
Main Methods:
- Retrospective analysis of 327 SP-RARP cases performed by eight experienced surgeons across three centers.
- Cumulative sum (CUSUM) analysis and piecewise linear regression to evaluate learning curves for OT and EBL.
- Piecewise multivariable logistic regression to adjust for potential confounding factors.
Main Results:
- The extraperitoneal (EP) approach demonstrated proficiency breakpoints at 55 cases for operative time (OT) and 97 cases for estimated blood loss (EBL).
- No clear proficiency plateau was observed for the transperitoneal (TP) approach, indicating persistent variability.
- Multivariable analysis confirmed case volume significantly impacted OT (p=0.048) but not EBL (p=0.12) for the EP approach.
Conclusions:
- This multicenter study provides the first evaluation of SP-RARP learning curves using CUSUM and piecewise regression.
- Clear proficiency thresholds were identified for the EP approach (OT at 55, EBL at 97 cases), with OT significance confirmed post-adjustment.
- The TP approach exhibited different learning dynamics, lacking a definitive proficiency plateau, suggesting distinct surgeon adaptation patterns.
