# Learning curve for laparoscopic radical prostatectomy

## TL;DR

This study examines the learning curve for a urology resident performing laparoscopic radical prostatectomy surgeries, showing improvements in surgical time and outcomes over time.

## Contribution

The study provides insights into the learning curve for laparoscopic radical prostatectomy performed by a single resident without supervision.

## Key findings

- Surgical time decreased significantly from 183 minutes in the first group to 130 minutes in the fifth group.
- Positive surgical margins were highest in groups three and four.
- Urinary continence improved from 66.7% in the first group to 86.7% in the fourth group.

## Abstract

While robotic prostatectomies are gaining popularity, laparoscopic and open surgeries remain prevalent in Central and Eastern Europe due to their cost‑effectiveness. In Poland, many urology residents report insufficient laparoscopic training. This study retrospectively evaluated the learning curve for laparoscopic radical prostatectomy (LRP).

This paper aimed to assess the learning curve of a single resident performing extraperitoneal LRP.

We analyzed 72 patients who underwent LRP between 2016 and 2020 at a single center, divided into 5 groups (G1–G5) according to chronological order. The procedures were per‑ formed by a single urologist without on‑site supervision. Outcomes included operative duration, length of hospital stay, complications, transfusion rates, histopathology findings, biochemical recurrence, and urinary incontinence.

Patient characteristics were similar across all groups. The median (interquartile range [IQR]) age ranged from 61 (54–66) to 68 (66–70) years, and the median (IQR) prostate‑specific antigen con‑ centration, from 6.7 (5.4–8.5) to 15 (6.3–19.3) ng/ml. Higher Gleason scores were more common in the G3 and G4 groups (P = 0.05) than in the other groups. Surgery time decreased from 183 minutes in the G1 group to 130 minutes in the G5 group (P <0.001). The rates of positive surgical margins were the highest in the G3 and G4 groups (53.3% and 46.7%, respectively; P = 0.02). The rate of urinary continence improved from 66.7% in the G1 group to 86.7% in the G4 group (P = 0.36); however, without any significant difference among all groups. Biochemical recurrence rates tended to be lower in the G4 and G5 groups (6.7% and 8.3%, respectively), but the difference across all groups was nonsignificant. Grade III–V complications occurred only in the G1 group.

Surgical outcomes improved after 15 procedures, and the oncological outcomes, after 45, with functional improvement observed later. Performing hundreds of surgeries may be required to achieve high proficiency in performing LRP.