Extraperitoneal single-port robot-assisted radical prostatectomy using da Vinci Xi platform: learning curve and...

Area of Science:

• Urology
• Robotic Surgery
• Surgical Oncology

Background:

• Localized prostate cancer management often involves radical prostatectomy.
• Minimally invasive techniques, including robotic-assisted surgery, are increasingly adopted.
• Single-port robotic surgery offers potential advantages in reduced invasiveness.

Purpose of the Study:

• To evaluate the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP).
• To assess perioperative, functional, and oncological outcomes of SP-RARP using the da Vinci Xi platform.
• To identify distinct learning phases for surgeons performing SP-RARP.

Main Methods:

• Retrospective cohort study of 200 patients with localized prostate cancer undergoing extraperitoneal SP-RARP.
• Data collected from June 2021 to January 2023 by a single surgeon.
• Cumulative sum analysis used to define learning curve phases.

Main Results:

• Significant reductions observed across learning phases: operative time (19.5%), estimated blood loss (40.9%), and positive surgical margin rate (61.1%).
• At 12 months post-surgery: 98.0% continence recovery and 5.0% biochemical recurrence.
• 8.5% minor complications, no severe events reported; procedure deemed safe and feasible.

Conclusions:

• Extraperitoneal SP-RARP with da Vinci Xi is a safe, feasible, and reproducible technique for localized prostate cancer.
• Favorable perioperative, functional, and oncological outcomes are achievable, even during initial skill acquisition.
• The study identified distinct learning phases, highlighting a manageable learning curve for surgeons.