Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method.

Abstract

Single-port (SP) was recently implemented as an alternative robotic system for extraperitoneal radical prostatectomy (EPP). The primary aim of this study is to characterize the learning curve (LC) for the SP-EPP for an experienced multi-port (MP) robotic surgeon. All consecutive SP-EPP cases (N=150) performed by a single surgeon from initial experience in a high-volume tertiary care center were prospectively included. The cumulative sum Method (CUSUM) was used retrospectively to create the LCs for SP-EPP surgery based on several outcomes used to gauge the surgeon's performance relative to those previously obtained with the current gold standard (MP-Robot Assisted Radical Prostatectomy (MP-RALP);N=80). The evaluation of a surgical transition from MP to SP prostatectomy analyzed with the Statistical Process Control and the CUSUM method revealed a smooth and safe LC divided into four phases of 30-40 cases and a decrease of surgical time, blood loss and postoperative complication rate after the first learning phase.