Introduction and Background

The study presented in the Journal of Robotic Surgery evaluated the learning curve associated with Extraperitoneal Single-Site Robotic-Assisted Radical Prostatectomy (ss-RARP) using a cumulative sum (CUSUM) analysis. This surgical technique has gained traction due to its reduced incision sizes and superior cosmetic outcomes, though challenges such as limited operating space and the ‘chopstick effect’ have hindered its widespread adoption. Understanding the learning curve is essential for assessing the effectiveness of training and establishing the number of cases required for proficiency in this technique.

Study Design and Methodologyhe research analysed a cohort of 100 patients who underwent ss-RARP performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023. The study employed a retrospective design, focusing on key perioperative outcomes such as operative duration and estimated blood loss. The CUSUM methodology allowed for tracking trends over time and identifying critical milestones in the surgeon’s skill development.

Results

The average age of the patients was 71.44 years, with a median operative time of 119.53 minutes and median blood loss of 49.9 ml. The analysis revealed a cubic polynomial model as the best fit for the learning curve of Extraperitoneal Single-Site Robotic-Assisted Radical Prostatectomy, indicating that proficiency was generally achieved after approximately 27 cases. Notably, blood loss significantly decreased from 75.93 ml during the learning phase to 40.27 ml in the proficiency phase, while operative time remained statistically similar across both phases.

Learning Curve Insights

The study identified distinct phases in the learning curve: the initial learning phase (cases 1-27) and the proficient phase (cases 28-100). The operative time peaked at the 11th case, suggesting that the surgeon achieved substantial efficiency quickly. Conversely, the peak for blood loss occurred later at the 27th case, indicating that mastering haemostatic techniques required more extensive experience.

Clinical Implications

The findings suggest that structured surgical training programs should emphasize workflow optimization and team coordination during the initial learning phase. Advanced training focused on precision techniques and haemostasis is essential for later stages of skill acquisition. This structured approach can enhance surgical safety and improve patient outcomes.

Discussion and Conclusion

The study underscores the effectiveness of Extraperitoneal Single-Site Robotic-Assisted Radical Prostatectomy as a surgical method, highlighting that proficiency can be reached after performing approximately 27 cases. The research advocates for further multicentre studies and longer follow-up periods to validate the findings and optimize training protocols. Overall, ss-RARP represents a viable alternative to traditional multi-port approaches, offering potential benefits in patient recovery and satisfaction.

This comprehensive analysis not only contributes valuable insights into the learning curve of ss-RARP but also emphasizes the importance of targeted training strategies in surgical education.

SOURCE: https://link.springer.com/article/10.1007/s11701-024-02202-3

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