Evaluating the learning curve for single-port radical prostatectomy: a multi-institutional cohort analysis
Recommended Citation
Finocchiaro A, Buffi N, Aljoulani M, Almajedi M, Stephens A, Viganò S, Bertini A, Biasatti A, Valenzi FM, Ficarra V, Sorce G, Salonia A, Briganti A, Montorsi F, Lughezzani G, Vourganti S, Autorino R, Crivellaro S, Nelson RJ, Rogers C, and Abdollah F. Evaluating the learning curve for single-port radical prostatectomy: a multi-institutional cohort analysis. World J Urol 2025;43(1):621.
Document Type
Article
Publication Date
10-22-2025
Publication Title
World journal of urology
Keywords
Humans, Learning Curve, Prostatectomy, Male, Retrospective Studies, Robotic Surgical Procedures, Middle Aged, Aged, Cohort Studies, Prostatic Neoplasms, Clinical Competence
Abstract
BACKGROUND/OBJECTIVES: Single-port robot-assisted radical prostatectomy (SP-RARP) represents an evolution in minimally invasive surgery but introduces unique technical challenges. Existing evidence on SP-RARP learning curves is limited to single-center or single-surgeon experiences. This multicenter study aimed to define proficiency milestones for SP-RARP across multiple surgeons using robust statistical methods.
MATERIALS AND METHODS: We retrospectively analyzed data from 327 patients who underwent SP-RARP performed by eight experienced multiport surgeons transitioning to the single-port platform across three U.S. centers (2019-2024). Learning curves for operative time (OT) and estimated blood loss (EBL) were evaluated using cumulative sum (CUSUM) analysis and piecewise linear regression. Piecewise multivariable logistic regression was used to adjust for confounders.
RESULTS: Of the 327 cases, 111 were transperitoneal (TP) and 216 extraperitoneal (EP). No clear proficiency plateau was observed for the TP approach, with persistent variability in OT and EBL. In contrast, EP cases demonstrated breakpoints at 55 cases for OT (95% CI: 53.8-55.6; R² = 0.91) and 97 cases for EBL (95% CI: 92.3-101.1; R² = 0.97). Multivariable analysis confirmed a significant association between case volume and OT (p = 0.048), but not for EBL (p = 0.12).
CONCLUSION: This is the first multicenter study to evaluate SP-RARP learning curves using CUSUM and piecewise regression. Clear proficiency thresholds were identified for the EP approach (OT at 55, EBL at 97 cases), though only OT was confirmed after adjustment. No definitive plateau was reached for the TP approach, suggesting different learning dynamics.
Medical Subject Headings
Humans; Learning Curve; Prostatectomy; Male; Retrospective Studies; Robotic Surgical Procedures; Middle Aged; Aged; Cohort Studies; Prostatic Neoplasms; Clinical Competence
PubMed ID
41123690
Volume
43
Issue
1
First Page
621
Last Page
621
