# Robot-Assisted Radical Prostatectomy Beyond the Learning Curve: Does Prior Laparoscopic Experience Influence Surgical Outcomes?

## TL;DR

This study compares surgical outcomes of robot-assisted prostatectomy performed by surgeons with different training backgrounds after they have mastered the robotic technique.

## Contribution

The study explores whether prior laparoscopic experience affects outcomes after robotic proficiency is achieved, providing insights into surgeon training pathways.

## Key findings

- Early functional recovery and oncological outcomes were similar between surgeons with different backgrounds.
- Overall pentafecta achievement was limited and similar in both groups, mainly due to positive surgical margins.
- Operative time was significantly shorter for one surgeon, but functional outcomes and complication rates were comparable.

## Abstract

Robot-assisted radical prostatectomy is increasingly performed by surgeons with heterogeneous training backgrounds. In recent years, a growing number of surgeons are being incorporated directly into robotic programs without prior laparoscopic experience, raising questions about the relevance of previous surgical background once robotic proficiency is achieved. Whether prior laparoscopic training influences patient outcomes after completion of the robotic learning curve remains unclear. In this retrospective study, we compared early oncological and functional outcomes after robot-assisted radical prostatectomy between two experienced robotic surgeons with different surgical backgrounds, analyzing only procedures performed after the learning curve had been surpassed. Early functional recovery and oncological outcomes were similar between surgeons, while overall pentafecta achievement was limited in both groups. Failure to achieve pentafecta was mainly driven by positive surgical margins rather than functional outcomes. These findings suggest that, once robotic proficiency is achieved, early results may be more influenced by tumor characteristics and surgical strategy than by previous laparoscopic experience. However, given the exploratory nature of the study and limited follow-up, the results should be interpreted with caution.

Background/Objectives: Robot-assisted radical prostatectomy (RARP) is widely used in contemporary prostate cancer surgery; however, surgeons enter robotic practice through heterogeneous training pathways. This study aimed to compare early oncological and functional outcomes after RARP between two experienced robotic surgeons with different surgical backgrounds after completion of the learning curve. Methods: We conducted a retrospective, consecutive, single-center study including patients undergoing RARP after completion of the learning curve (> 40 cases) by two experienced robotic surgeons with different surgical backgrounds. Baseline characteristics, perioperative variables, and early oncological and functional outcomes were compared between surgeons. Pentafecta achievement was assessed as an exploratory composite outcome. Appropriate non-parametric and categorical statistical tests were applied as appropriate. Results: Ninety-three patients were included (55 operated on by surgeon A and 38 by surgeon B). Preoperative clinical and pathological characteristics were largely comparable between groups, except for prostate volume. Median operative time was significantly shorter for surgeon A (70 vs. 120 min, p < 0.001). Postoperative morbidity was low, with no major complications and no differences in length of hospital stay. At 6 months, urinary continence and erectile function recovery rates were high and comparable between surgeons. Oncological outcomes, including positive surgical margin rates and biochemical recurrence, did not differ significantly, although recurrence events were infrequent and follow-up was limited. Overall pentafecta achievement was modest and similar between groups (23.6% vs. 21.1%, p = 0.77), with positive surgical margins emerging as the main limiting factor. Conclusions: In this exploratory post-learning curve analysis, early oncological and functional outcomes after RARP were similar between surgeons with different surgical backgrounds. These findings should be interpreted cautiously and considered hypothesis-generating.