Preliminary results of robot-assisted laparoscopic radical prostatectomy (RALP) after fellowship training and experience in laparoscopic radical prostatectomy (LRP)


Philippe Wolanski, Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. e-mail:


What's known on the subject? and What does the study add?

The ‘learning curve’ of surgeons transitioning from open radical prostatectomy (RP) to robot-assisted laparoscopic RP (RALP) has been well examined. To achieve the same results as open RP, this learning curve is known to be considerable. However, the transition to RALP for surgeons experienced in laparoscopic RP (LRP) has been less well documented. Given that RALP replicates the LRP technique but with a robot that allows such surgery to performed more easily, one can hypothesise that any ‘learning curve’ would be minimised.

This study supports the hypothesis that previous fellowship training and experience in LRP eliminates any significant learning curve effect when transitioning to the robotic interface.


  • • To ascertain whether prior experience in laparoscopic radical prostatectomy (LRP) shortens the ‘learning curve’ and therefore improves early patient outcomes when transitioning to robot-assisted laparoscopic RP (RALP).

Patients and methods

  • • Retrospective analysis of prospectively collected data of the most recent 87 cases of LRP compared with the initial 73 cases of RALP.
  • • LRP was performed via a five-port extraperitoneal approach, while transperitoneal RALP was performed using a four-arm da Vinci S unit.


  • • The median operative duration for RALP (skin-to-skin, including docking time) rapidly reduced, although never exceeded 3.5 h, for each consecutive set of 10 cases.
  • • Oncological outcomes were preserved with no cases of pT2 positive surgical margins (PSMs) in any group. pT3 PSM rates were not significantly different at 50% and 38% for LRP and RALP, respectively.
  • • Penetrative intercourse rates at 3 months for bilateral nerve-sparing procedures in preoperatively potent patients were similar, at 50% for LRP (median Sexual Health Inventory for Men [SHIM] 17) and 48.1% for RALP (median SHIM 18). The pad-free rate at 3 months was significantly better for RALP at 59.7%, compared with 39.8% for LRP (P= 0.043).
  • • Complications were minimal and comparable for the two groups except for a higher LRP radiological anastomotic leak rate of 16 vs 1% (P= 0.004).


  • • In this comparative series fellowship training and prior experience in LRP resulted in no significant RALP learning curve with regards to oncological and functional outcomes, while maintaining a low complication rate.
  • • A short learning curve existed for operative duration but this improved rapidly and there were no prolonged cases.
  • • Differences in early continence and radiological leaks may reflect changing from an interrupted anastomosis (LRP) to a continuous anastomosis with posterior rhabdosphincter reconstruction (RALP).