Robot-Assisted Radical Prostatectomy Beyond the Learning Curve: Does Prior Laparoscopic Experience Influence Surgical...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer.
• Surgeons' training pathways for RARP are diverse.
• The impact of different surgical backgrounds on RARP outcomes is not well-established.

Purpose of the Study:

• To compare early oncological and functional outcomes of RARP between two experienced robotic surgeons with distinct surgical backgrounds.
• To evaluate outcomes after surgeons have completed their learning curves (>40 cases).

Main Methods:

• Retrospective, single-center study of 93 patients undergoing RARP.
• Comparison of baseline characteristics, perioperative variables, and early outcomes between two surgeons.
• Assessment of urinary continence, erectile function, surgical margins, and biochemical recurrence.
• Exploratory analysis of pentafecta achievement.

Main Results:

• Operative time was significantly shorter for surgeon A (70 min) vs. surgeon B (120 min).
• Postoperative morbidity was low, with no major complications and similar hospital stays.
• Urinary continence and erectile function recovery rates were high and comparable at 6 months.
• Oncological outcomes (margin rates, recurrence) and pentafecta achievement were similar between surgeons.

Conclusions:

• Early oncological and functional outcomes after RARP are comparable between experienced surgeons with different backgrounds post-learning curve.
• Positive surgical margins were the primary factor limiting pentafecta achievement.
• Findings are exploratory and hypothesis-generating, warranting cautious interpretation.