The Learning Curve And Factors Influencing Analysis For Transvesical Robot-assisted Laparoscopic Radical Prostatectomy

Objective:To evaluate the learning curve and its influential factors of Transvesical robot-assisted laparoscopic radical prostatectomy(TvRARP)and Single-Port transvesical robot-assisted laparoscopic radical prostatectomy(SP-TvRARP)performed by the single surgeon.Methods:We retrospectively collected clinical and pathological data of 40 early TvRARP cases;20 early SP-TvRARP cases and 40 Standard retropubic robot-assisted laparoscopic radical prostatectomy(Sr RARP)cases during the same period performed by the single surgeon from July 2018 to January 2021 at the First Affiliated Hospital of Nanchang University.The clinical outcomes were compared and the learning curves of TvRARP and SP-TvRARP were estimated by cumulative sum analysis(CUSUM),and further divided into different phases of learning improvement and mastering proficiency according to the results of the respective learning curves,and the clinical and pathological data of the different phases were compared and analyzed.Results:There were no statistical differences among the three groups of TvRARP,SP-TvRARP,and Sr RARP in terms of patient age,BMI,preoperative PSA and prostate volume,clinical T-stage,preoperative pathological Gleason score,intraoperative operative time and estimated blood loss,pathological T-stage,postoperative pathological Gleason score,positive surgical margin rate,postoperative hospital stay,and perioperative complications(All P > 0.05),whereas TvRARP and SP-TvRARP were superior to Sr RARP in terms of the duration of postoperative catheterization remaining and immediate urinary control rate(All P < 0.05).CUSUM analysis was used to estimate the learning curves of TvRARP and SP-TvRARP,and the results showed that the learning curves of TvRARP and SP-TvRARP were 12 and 8 cases,respectively,in which the operative time of TvRARP and SP-TvRARP was significantly longer than that of Sr RARP in the phases of learning improvement(All P < 0.05),while there was no statistical difference between them and Sr RARP in phases of mastering proficiency(All P >0.05).Further analysis of perioperative outcomes at different phases of TvRARP and SP-TvRARP showed that there were no statistical differences in age,BMI,preoperative PSA and prostate volume,clinical T-stage,preoperative pathological Gleason score,pathological T-stage,postoperative pathological Gleason score,positive surgical margin rate,postoperative hospital stay,and perioperative complications between TvRARP and SP-TvRARP in the phases of learning improvement and mastering proficiency(All P > 0.05).The differences between the TvRARP and SP-TvRARP in the phases of learning improvement and mastering proficiency were statistically significant in terms of intraoperative operative time and estimated intraoperative blood loss(P < 0.001,< 0.001,0.007,0.009,respectively).Conclusion:TvRARP and SP-TvRARP can be considered as a safe and feasible alternative technique to RARP and have better immediate urinary control advantages,and further follow-up is needed for long-term results.The learning curve for TvRARP and SP-TvRARP can be significantly shortened for urologists with extensive experience in urologic laparoscopic surgery and other procedures for RARP(anterior approach,posterior approach),and it takes approximately 12 and 8 cases to pass the learning curve of TvRARP and SP-TvRARP,respectively,to reach the level of Sr RARP in the same period.Being in the TvRARP and SP-TvRARP learning improvement phase did not significantly affect the positive surgical margin rate,postoperative hospital stay,and perioperative complications,but passing through the learning improvement phase significantly improved intraoperative operative time and estimated intraoperative blood loss.