To study the learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP).

In total, 350 consecutive patients underwent RALP from March 2012 to August 2015, performed by three surgeons with different background of surgical experiences, were included in the study. The mean age of the patients was 67 years (range 48 to 87 years), median pretreatment serum PSA level was 12 ng/ml (range 0.308 to 214 ng/ml). Clinical stages were between T_1aN₀M₀~T_3bN₁M₀ and T_3bN₁M_0,in which 74 cases staged ≤T_1c,119 cases staged T_2a,63 staged T_2b,68 staged T_2c,and 26 staged ≥T_3a cases. Operative time, intraoperative blood loss, and length of postoperative stay were collected for the major parameters of learning curve analyses.

The mean operative time (include preoperative set up time of the robotic surgical system) was 220.5 min (range 120 to 555 min). Intraoperative blood loss averaged 216.3 ml (range 20 to 1300 ml), with blood transfusion performed in 5 cases. Postoperative hospital stay was 9.3 days (range 4 to 32 days). With accumulation of surgical experience throughout the learning curve, significant improvements were observed regarding operative time (P<0.01), intraoperative blood loss (P<0.01), and postoperative hospital stay (P<0.01). All 3 surgeons had successfully passed the first learning curve, while surgeon 1 reached the second plateau of the learning curve.

There is a two-plateau learning curve in the study process of RALP. The surgical background of surgeons might have influence on the length of the learning curve.

Prostatic neoplasms; Learning curve; Robotic-assisted laparoscopic radical prostatectomy