Extraperitoneal single-port robot-assisted radical prostatectomy using da Vinci Xi platform: learning curve and outcome analysis

This single-center retrospective cohort study evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy using the da Vinci Xi platform for localized prostate cancer. The data of 200 consecutive patients with localized prostate cancer who underwent this procedure by a single surgeon at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Shanghai, China) from June 2021 to January 2023 were collected. Key outcomes included operative time, estimated blood loss, complications, biochemical recurrence, and continence recovery. A cumulative sum analysis identified three learning phases: initial learning (≤50 cases), consolidation (51-155 cases), and proficiency (>155 cases). Across phases, operative time decreased by 19.5% (from 174 min to 140 min), estimated blood loss decreased by 40.9% (from 115 ml to 68 ml), and positive surgical margin rate decreased by 61.1% (from 35.2% to 13.7%). At 12 months, 98.0% of the patients achieved continence, and 5.0% experienced biochemical recurrence. Minor complications occurred in 8.5% of the cases, with no severe events reported. Despite its technical challenges and steep learning curve, the extraperitoneal single-port robotic prostatectomy using the da Vinci Xi platform was observed to be safe, feasible, and reproducible, yielding favorable perioperative, functional, and oncological outcomes, even during the initial phase of skill acquisition.