Learning curve of Versius-assisted radical prostatectomy: role of prior experience and proctoring

To assess the learning curve for radical prostatectomy (RP) with the Versius system (CMR Surgical, Cambridge, UK) and evaluate the transfer of skills from previous robotic and laparoscopic practice.

This prospective cohort study included patients with localised prostate cancer undergoing Versius-assisted RP. Four surgeons participated: two with extensive prior robotic experience (>500 Da Vinci Surgical System [Intuitive Surgical Inc., Sunnyvale, CA, USA] RPs) and two with laparoscopic but no robotic background, operating under structured proctoring. Outcomes included objective measures such as console time or novel hand motion volumetry. Proficiency was defined by Learning Curve Cumulative Sum (LC-CUSUM) analysis with thresholds of console time <165/180 min (without/with lymphadenectomy) and absence of significant positive surgical margins.

A total of 151 consecutive patients were included. Pre- and postoperative characteristics were comparable across surgeons. There were clinically and statistically significant improvements in operative time and hand motion metrics with increasing experience. Proficiency was achieved after 23 cases by experienced surgeons and after 37 by novel surgeons. The overall positive margin rate was 27.8%, with only two cases exceeding the ≥3 mm threshold in nerve-sparing procedures. Major complications (Clavien-Dindo Grade ≥III) only occurred in four (2.6%) patients.

Surgical proficiency in Versius-assisted RP was achieved in <40 cases, particularly among surgeons with prior robotic experience. Structured proctoring shortened the learning curve, and hand motion volumetry emerged as an objective marker of skill, supporting its use in training and competency assessment.