Photo Credit: mku018

The following is a summary of “Learning Curve for Single-port Robot-assisted Urological Surgery: Single-center Experience and Implications for Adoption,” published in the September 2024 issue of Urology by Pellegrino et al.

Understanding the learning curve of the da Vinci single-port (SP) surgical robot is essential for optimizing its adoption, training, and enhancing surgical safety and efficiency. This study aims to evaluate the impact of both overall experience (O-EXP) and procedure-specific experience (PS-EXP) on perioperative outcomes across various SP surgeries. 

A retrospective analysis was conducted on 387 consecutive SP surgeries performed by a high-volume surgeon between December 2018 and July 2023, including SP robot-assisted radical prostatectomy (SP-RARP), robot-assisted simple prostatectomy (SP-RASP), and robot-assisted nephrectomy (SP-RANP). Multivariable logistic regression assessed the relationship between surgeon experience and postoperative outcomes, while locally weighted scatterplot smoothing was used to examine the risk of complications by O-EXP. 

Of the 387 procedures, 172 (44%) were SP-RARP, 53 (14%) SP-RASP, and 162 (42%) SP-RANP. The overall complication rate was 17%, with 6% experiencing severe complications (Clavien-Dindo grade ≥3) and 8% requiring readmission. Both O-EXP and PS-EXP were significantly associated with a reduction in complications. The odds ratios for complications per 10-procedure increment were 0.83 (95% CI: 0.76–0.89) for PS-EXP and 0.93 (95% CI: 0.90–0.96) for O-EXP. PS-EXP was also associated with shorter operative times (β = −3.9, 95% CI: −4.9 to −2.9). The learning curve plateaued after 30 SP-RASP, 70 SP-RANP, and 150 SP-RARP cases. Limitations include the study’s retrospective nature, single-surgeon focus, and the lack of functional outcome data. These findings highlight the distinctive learning curve of the da Vinci SP robot, indicating that SP-RASP and renal procedures should be prioritized in early SP surgery training. In contrast, more complex procedures like SP-RARP should be attempted after gaining sufficient platform experience.

Source: sciencedirect.com/science/article/abs/pii/S240545692400172X