Learning curve and evolution of a urological robotic surgeon's practice with da Vinci robot-assisted surgery: console...

To characterize the early surgeon-level and institutional learning process during adoption of da Vinci robot-assisted urological surgery, with chronological console-time analysis in robot-assisted radical prostatectomy (RARP) and complementary perioperative, complication, and pathological outcomes.

This retrospective observational study included 60 robotic procedures performed by one principal surgeon between June 2024 and June 2026. The principal learning cohort comprised 38 chronologically ordered RARP procedures with complete console-time data. Linear regression assessed console time by case order. The first and last 10 cases were compared using Welch's t test, with 95% confidence intervals (CIs). Complications were categorized using Clavien-Dindo when treatment was sufficiently documented. Missing variables were not imputed.

The 60-procedure series included 38 RARP (63.3%) and 22 other robotic urological procedures. In RARP, mean console time was 197.1 ± 56.8 min (median 189; range 83-400). Mean console time was 191.2 ± 66.9 min in the first 10 cases and 171.6 ± 37.1 min in the last 10 (difference 19.6 min, 95% CI -32.3 to 71.5; p = 0.431). Linear regression showed a slope of -0.76 min/case (95% CI -2.47 to 0.95; R²=0.022; p = 0.373). No open conversion occurred. Clavien-Dindo complications were grade I in 4 (10.5%), grade II in 7 (18.4%), and grade IIIa in 1 (2.6%); no grade IIIb-V event was documented. Pelvic lymph-node dissection was documented in 33/38 cases (86.8%), and positive surgical margins occurred in 9/38 (23.7%).

Console time decreased numerically during the early RARP experience, but neither the chronological regression nor the first-versus-last block comparison reached statistical significance. The findings describe an early surgeon-team-institution learning process and do not establish completion of a proficiency learning curve.