Differences in Perioperative, Postoperative, Histological, and Early Functional Outcomes during Curricular and...

Robot-assisted radical prostatectomy (RARP) is one of the main options for the surgical treatment of localized prostate cancer. Following the standardization and establishment of the procedure as a routine surgical approach, formal training curricula were introduced to provide structured education for future console surgeons. However, a considerable number of surgeons continue to be trained outside of these standardized programs. This study aimed to compare the perioperative, postoperative, histopathological, and early functional outcomes of two surgeons who underwent different types of training: curriculum-based training (CC) versus non-curriculum-based (hybrid) training (non-CC).

We performed a retrospective analysis of the surgical outcomes of two surgeons trained through different pathways in two separate centers. One surgeon completed formal curriculum-based training in accordance with the EAU/ERUS guidelines for the standardized modular training for RARP, while the other followed a hybrid, non-curricular training model. We evaluated key outcome parameters through a multivariable regression analysis adjusted for age, T-status, and prostate volume.

A total of 83 patients were included, with 47 operated by the CC surgeon and 36 by the non-CC surgeon. Baseline characteristics were comparable between groups, except for higher initial PSA levels in the non-CC group (p = 0.023) and a more favorable Gleason score distribution in the CC group (p = 0.005). In the multivariate analysis, the CC group showed a significantly shorter hospital stay (median 6 versus 8 days, p < 0.001) and superior early postoperative continence (81% versus 56%, p = 0.02). Positive surgical margins were significantly less frequent in the CC group (4.3% versus 33%, p = 0.03). No significant differences were observed in estimated blood loss, transfusion rates, or major complications. Three-month continence outcomes were similar between groups.

A curriculum-based surgical training pathway can lead to improved outcomes for patients undergoing RARP. Standardized surgical education should serve as the foundation for training in the field of robot-assisted surgery. Further studies are needed due to selection bias and temporal asymmetry of the cohorts of this study.