Adoption of single-port robot-assisted radical prostatectomy following multiport xi experience: lessons from a...

To evaluate whether surgical proficiency acquired with the multiport Xi robotic platform facilitates the early adoption of single-port (SP) robot-assisted radical prostatectomy (RARP). We retrospectively analyzed the first 100 consecutive Xi and the first 100 consecutive SP RARP procedures performed by a single surgeon between March 2020 and July 2026. SP RARP was initiated after completion of the initial 100 Xi procedures. Learning curves were assessed using console-time cumulative sum (CUSUM) analysis with permutation-based change-point testing. Perioperative and pathologic outcomes were compared between platforms. Significant CUSUM change points were identified at case 24 for Xi and case 57 for SP (both P < 0.001). Despite the later SP change point, operative performance was relatively stable from early SP adoption. Median console time (67.0 vs. 97.5 min), operative time (95.0 vs. 145.0 min), and non-console time (28.0 vs. 44.0 min) were shorter with SP (all P < 0.001). Pelvic lymph node dissection was less frequent with SP (1.0% vs. 29.0%, P < 0.001). Thirty-day emergency department visits and readmissions did not differ between groups. Overall positive surgical margin rates were 13.0% with SP and 27.0% with Xi (P = 0.021), whereas stage-stratified rates did not differ significantly. Prior multiport Xi experience facilitated efficient adoption of SP RARP, with relatively short operative times from early SP use despite a later CUSUM change point. These findings suggest that robotic surgical proficiency may be transferable across platforms, while observed differences between platforms should be interpreted in the context of cumulative experience and procedural selection.