Objectives: Robotic-assisted laparoscopic radical prostatectomy (RALP) is an established trend in surgical treatment for localized prostate cancer in the USA; however, RALP is still in its infancy in Taiwan. To analyze the learn curve of perioperative outcomes between patients undergoing 90 cases of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon in Taiwan.

Methods: From Dec. 1 2005 to Aug. 2008, 146 procedures were performed by Robot in this division, among them 90 of 117 cases of RALP was performed by one surgeon. This study was a retrospective review of 90 consecutive patients who underwent RALP by one surgeon. To compare outcomes between patients undergoing first 30 cases (Group I: Infant Stage), second 30 cases (Group II: Children Stage) and third 30 cases (Group III: Adolescent Stage) of RALP. We evaluated preoperative parameters, operation parameters (operative time, vesicourethral anastomosis time, blood loss, transfusion and complication rates), and postoperative parameters (post-operative stay, catheter duration, cystography received, continence rate, sexual function and histopathologic factors).

Results: Preoperative clinical parameters were similar between 3 groups except higher biopsy Gleason score in Group II and Group III than Group I (7.03±1.16 versus 7.00±1.17 versus 6.13±0.90, p <0.001). The console time was shorter in Group II and Group III than Group I (3.15 hours versus 3.19 hours versus 3.75 hours) and less blood loss in Group II and Group III than Group I (227 ml vs 191 ml vs 314 ml), they did not reach significant differences. The incidence of performing bilateral pelvic lymph node dissection was higher Group III than Group I and Group II (96.7% vs. 73.3% vs. 70%, p<0.05 ). Significant differences were found in vesicourethral anastomosis time (46.38 min for Group I vs. 31.0 min for Group II vs. 29 .9 min for Group III, p<0.01). The incidence of neurovascular bundle preserving was lower in Group III than Group I and Group II (16.6% vs. 53.3%. vs. 46.7 %, p<0.01 ). The postoperative stay were statistically significant shorter from 7.33 days for Group I to 3.93 days for Group II to 3.07 days for Group III. Positive surgical margins, continence rates, potency and intercourse rates at 12 months were similar between the groups.

Conclusions: After the three stages of learning curve of RALP with every 30 cases showed significantly less vesicourethral anastomosis time and shorter postoperative stay. Selection of decreased the incidence neurovascular bundle preserving in Group III, but the incidence of surgical margin in pT3 prostate cancer was not significantly reduced. Learning curve of decreasing positive surgical margin for tumor control is more than 90 cases of RALP.