Multi-Institutional Learning Curve Analysis of Three Single-Port Robotic Radical Prostatectomy Approaches From the SPARC

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Journal of Urology

Abstract

NTRODUCTION AND OBJECTIVE: Since the clearance of the da Vinci SP platform for single-port (SP) robot-assisted radical prostatectomy (RARP) in 2018, multiple robotic surgeons have adopted various approaches for this procedure, including transperitoneal (TP), extraperitoneal (EP), and transvesical (TV). One argument against the adoption of SP RARP is the hypothesized steep learning curve (LC). Our aim is to present data from the Single-Port Advanced Research Consortium (SPARC) regarding the LC for SPTP, EP, and TV RARP. METHODS: Retrospective analysis of all consecutive SP RARP cases performed in 13 centers from November 2020 to October 2023.Cases were categorized according to approach (TP, EP, or TV) and further divided into two groups: the first 25% and the last 25% per-formed by each surgeon. We only considered surgeons with a minimum experience of 10 cases per approach. We compared groups for each approach using non-parametric methods to assess changes in patient selection and perioperative outcomes. RESULTS: A total of 14 experienced robotic surgeons per-formed 548 TP, 952 EP, and 250 TV SP RARP cases. Two surgeons exclusively performed the TP approach. Four surgeons initiated their LC with TP and transitioned to EP at a median point of 25 cases. One surgeon exclusively conducted TV cases. The remaining surgeons performed a combination of the three approaches since their adoption of SP RARP. When comparing the first 25% to the last 25%, larger prostates are operated on in TP and TV approaches with significantly less blood loss. Operative time was shorter with more experience in EP and TV approaches. There are two factors to which we attribute the increase in positive margins rate in the TV approach, (1) selection of patients with more aggressive disease and (2) increase in nerve-sparing performance. There was no difference in intraoperative complications rate. The length of stay and postoperative complications rate significantly decreased for the latest EP cases .CONCLUSIONS: In our experience with 1750 SP RARP cases during a three-year timeframe, we found that the LC varies among different approaches, with improvements in surgical efficiency observed for the EP and TV techniques. Intraoperative complication rates were very low regardless of the approach and stage of LC. These findings provide valuable insights into the adoption of SP RARP.

Volume

211

Issue

5S

First Page

e1190

Comments

American Urological Association Annual Meeting, May 3-6, 2024, San Antonio, TX

DOI

10.1097/01.JU.0001009564.26544.1c.19

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