Objective: To report the peri-operative outcomes and positive surgical margin (PSM) and to analyze the surgical learning curve of one of the longest single-surgeon experiences in Thailand.

Materials and Methods: Between January 2013 and July 2018, 330 robotic-assisted laparoscopic radical prostatectomies (RALRPs) were performed. Patients’ data were collected retrospectively to evaluate peri-operative and pathological outcomes. These data included age, body mass index (BMI), serum prostate-specific antigen (PSA) levels, operative time, estimated blood loss (EBL), surgical laceration rate, length of hospital stay, clinical and pathological stage, Gleason score (GS) on biopsy specimen, specimen weight (g), and marginal status.

Results: Of the 330 RALRPs performed, the median total operation time, median EBL, surgical laceration, length of hospital stay, and total PSM were 190 (165 to 230) minutes, 300 (200 to 500) ml, 0.6% (2), 5 (4 to 8) days, and 38%, respectively. The present surgeon’s learning curve indicated that operative times, EBL, and PSM in pathologically organ-confined disease (pT2) were strongly correlated with the cumulative experience from the initial 50 cases (p<0.001 and 0.017, respectively) and the initial 100 cases (p=0.007), respectively. However, surgical laceration and length of hospital stay were not correlated with the surgeon’s cumulative experience (p=0.596 and 0.073, respectively).

Conclusion: The peri-operative outcomes and PSM for RALRP are promising. The initial learning curve was about 100 cases for a surgeon to adequately master the required skills.

Keywords: Learning curve, Prostate cancer, Radical prostatectomy, Robot-assisted laparoscopic surgery, Perioperative outcome

Received 12 Dec 2018 | Revised 8 Apr 2019 | Accepted 12 Apr 2019