Operative time-based learning curve and surgical outcomes of laparoscopic radical prostatectomy in a surgeon with limited open surgery experience

To assess the learning curve and perioperative, oncological, and functional outcomes of laparoscopic radical prostatectomy (LRP) performed by a surgeon who initiated a LRP program in a low-volume center with minimal prior experience in open radical prostatectomy and no direct proctorship or on-site mentoring- a less frequently reported setting for the learning curve. This retrospective study included 90 consecutive patients who underwent LRP. Cases were chronologically divided into three groups of 30 for learning-curve evaluation. Patient demographics, PSA levels, ISUP grade, operative time (OT), estimated blood loss, transfusion requirement, length of hospital stay, catheterization duration, pathological outcomes, and one-year PSA recurrence, continence, and erectile function were analyzed. CUSUM and regression models were used to identify proficiency thresholds and predictors of OT. OT decreased steadily with experience and reached a proficiency plateau after the 61st case (Group 1 cases 1–30: 251.3 ± 52.3 min vs. Group 3 cases 61–90: 218.7 ± 40.4 min; p = 0.027). Surgical experience was a strong independent predictor of shorter operative time (β = -0.491, p = 0.008), whereas estimated blood loss, prostate volume, and lymph node dissection prolonged operative duration. After adjustment, each additional case reduced operative time by approximately 0.49 min. Length of hospital stay also decreased significantly with experience (Group 1: 5.5 days vs. Group 3: 4.1 days; p < 0.001). Blood loss and transfusion rates remained low. The frequency of lymph node dissection increased with experience (p = 0.022). PSA recurrence rates were similar across groups. Preservation of erectile function improved from 23.3% to 50.0%, while continence outcomes stayed similar. A surgeon with limited prior experience in open radical prostatectomy and no direct proctorship or on-site mentoring reached proficiency in LRP after 61 cases, with ongoing improvement in functional outcomes. However, these findings should be considered exploratory due to the retrospective design and limited sample size. For surgeons starting LRP, early-stage patient selection—especially choosing patients with smaller prostates and no need for lymph node dissection—may help reduce operative times and improve initial results. With proper baseline training and structured support when available, LRP can be safely performed in low-volume centers while maintaining perioperative and functional outcomes comparable to published benchmarks. Retrospectively registered.