Determining the learning curve for robot-assisted radical perineal prostatectomy in surgeons familiar with robotic retropubic prostatectomy

Objective: To investigate the learning curve for robot assisted laparoscopic radical perineal prostatectomy (robotic RPP) for surgeons who already perform transperitoneal robot assisted laparoscopic radical prostatectomy. Material and Methods: A total of initial 120 robotic RPP cases were analyzed for perioperative data from single surgeon performing to determine the learning curve. Perioperative all data are collected including operation time, estimated blood loss, postoperative length of stay, complications and positive surgical margin results. The consecutive patients were classified into four groups: cases 1–30 (Group 1), cases 31–60 (Group 2), cases 61–90 (Group 3) and cases 91-120 (Group 4). Results: Median age of 61.4 (46-73) years and PSA level was 8.4 (2-32). Mean operative time was 143.2 minutes, and the length of surgery progressively decreased over time (from group 1 to group 4; P<001). Mean console time was 90.6 minutes and significant differences was found group 3 vs. 4 (p=0.047). The mean length of stay was 1.6 days, and significantly decrease after 60 cases over time (P<0.001). Mean removal of the urethral catheter significantly earlier in group 4 (P1vs4=0.012). There was no statistically significant difference between the groups with respect to pathologic tumor Gleason score, positive surgical margine of the specimen and complications. Conclusions: This study suggests that surgical qualification for robotic RPP can be obtained at least after 90 cases for an experienced robotic surgeon. Keywords: prostatectomy, robot-assisted, perineal, learning curve, prostate cancer