Robot-Assisted Radical Prostatectomy as the Institutional Standard: Complete Transition and Contemporary Outcomes...

Area of Science:

• Urology
• Surgical Oncology
• Robotics in Medicine

Background:

• Robot-assisted radical prostatectomy (RARP) is the leading surgical method for localized prostate cancer in high-volume centers.
• Limited real-world data exists on the complete institutional shift from open to robotic surgery.
• This study examines RARP outcomes and the transition from open radical prostatectomy (ORP) in a European center.

Purpose of the Study:

• To evaluate perioperative and early oncological outcomes of a contemporary RARP cohort.
• To characterize the institutional transition from ORP to RARP.
• To analyze surgeon-specific and institutional learning curves for RARP.

Main Methods:

• Analysis of 520 consecutive RARP patients (2023-2025).
• Assessment of perioperative, pathological, and biochemical outcomes (PSA ≥0.2 ng/mL for recurrence).
• Review of institutional data (2011-2025) for procedural trends and learning curve analysis using operative time and regression models.

Main Results:

• RARP volume increased significantly post-2018, comprising >99% of radical prostatectomies since 2023.
• Median operative time decreased (185 min to 165 min), with consistent learning curve improvements observed.
• Minimal blood loss, no transfusions, low complication rate (0.8%), and reduced hospital stay (1 day) were noted.
• 24-month biochemical recurrence-free survival varied by pathological stage (93.7% for pT2, 91.5% for pT3a, 82.1% for pT3b).

Conclusions:

• RARP demonstrates excellent perioperative safety, minimal morbidity, and favorable early oncological results in a high-volume setting.
• Complete institutional transition to RARP is feasible and safe.
• Demonstrated learning effects support RARP implementation as an institutional standard within structured programs.