Prontera Pier Paolo, Prusciano Francesca Romana, Marco Lattarulo, Tsaturyan Arman, Sciorio Carmine, Dibenedetto Francesco, Romano Lorenzo, Grossi Francesco Saverio
Department of Urology, "S.S. Annunziata" Hospital, Taranto.
Department of Urology, "S.S. Annunziata" Hospital, Taranto; Division of Urology, Hospital "Valle D'Itria", Martina Franca.
Arch Ital Urol Androl. 2025 Jun 30;97(2):13640. doi: 10.4081/aiua.2025.13640. Epub 2025 May 26.
This study aimed to evaluate the influence of prior laparoscopic experience on the learning curve and surgical outcomes of robotic-assisted radical prostatectomy (RaRP).
A retrospective analysis was performed on 101 patients treated between 2021 and 2023. Two surgeons at the beginning of their robotic learning curves were compared: one with extensive prior laparoscopic experience and the other without such a background. Perioperative, oncological, and functional outcomes were assessed, with a specific focus on Pentafecta criteria. Statistical analyses and cumulative sum (CUSUM) charts were employed to evaluate performance trends and surgical outcomes.
Surgeon A, with substantial prior laparoscopic expertise, demonstrated shorter operative times (p = 0.015), reduced intraoperative blood loss, and superior early functional outcomes. Specifically, patients operated on by Surgeon A exhibited higher pad-free continence rates and improved erectile function recovery at 12 months postoperatively (p < 0.01). Additionally, nerve-sparing procedures performed by Surgeon A showed a trend toward fewer positive surgical margins, although this difference did not reach statistical significance. CUSUM analysis revealed more stable and consistent performance trends for Surgeon A in achieving Pentafecta outcomes compared to Surgeon B.
Previous laparoscopic experience significantly contributes to shortening the learning curve for RaRP and enhancing early functional outcomes. This advantage is likely attributable to greater surgical anatomical knowledge. These findings highlight the importance of tailored training programs and the potential for skill transfer between laparoscopic and robotic approaches. Further studies are warranted to refine surgical education strategies and improve patient care outcomes.
本研究旨在评估既往腹腔镜手术经验对机器人辅助根治性前列腺切除术（RaRP）学习曲线及手术效果的影响。
对2021年至2023年期间接受治疗的101例患者进行回顾性分析。比较了处于机器人学习曲线初期的两位外科医生：一位有丰富的既往腹腔镜手术经验，另一位则无此背景。评估围手术期、肿瘤学及功能学结局，特别关注五联征标准。采用统计分析和累积和（CUSUM）图表评估手术表现趋势及手术效果。
外科医生A有丰富的既往腹腔镜手术经验，其手术时间较短（p = 0.015），术中失血减少，早期功能结局更佳。具体而言，由外科医生A实施手术的患者术后12个月无尿垫控尿率更高，勃起功能恢复更好（p < 0.01）。此外，外科医生A实施的保留神经手术切缘阳性情况有减少趋势，尽管这一差异未达到统计学意义。CUSUM分析显示，与外科医生B相比，外科医生A在实现五联征结局方面表现出更稳定、一致的手术表现趋势。
既往腹腔镜手术经验对缩短RaRP学习曲线及改善早期功能结局有显著作用。这一优势可能归因于更丰富的手术解剖学知识。这些发现凸显了量身定制培训计划的重要性以及腹腔镜手术与机器人手术方法之间技能转移的潜力。有必要进一步研究以完善手术教育策略并改善患者护理结局。
