The learning curve of single-port extraperitoneal robotic radical prostatectomy: Initial experience and outcomes from a newly graduated fellowship-trained robotic surgeon

Introduction and Objective: This study aims to evaluate the learning curve and perioperative outcomes of single-port extraperitoneal robotic radical prostatectomy (SP-EP-RARP) performed by a single surgeon at a high-volume academic institution. Methods: A retrospective review of a prospectively maintained database was conducted for patients who underwent SP-EP-RARP from September 2023 to August 2025. Key metrics included operative time, estimated blood loss, conversion rate, nerve-sparing status, pathological margin status and continence (0–1 pad for safety), and 30-day complication rate. Descriptive statistics were used, and outcomes were analysed chronologically to assess for trends suggesting a learning curve. Results: The cohort included 53 patients who underwent extraperitoneal SP-EP-RARP. Median operative time was 213 min (IQR: 145–281). Median estimated blood loss was 100 mL (IQR: 75–125). Nerve-sparing was attempted in 75.5% of cases. No assist or plus one ports were utilized. Final pathology revealed pT2 disease in 64.1% (34 cases), pT3a in 32.1% (17 cases) and pT3b in 3.7% (2 cases). Overall positive margin rate was 26.4%. Thirty-day Clavien–Dindo Grades I–II complication rates were 11.3%, and no major complications or 90-day complications were reported. Continence rates at 6 weeks, 3 months and 6 months were 72%, 72% and 75%, respectively. Stabilization of operative times and intraoperative outcomes occurred after approximately 25–30 cases. Conclusion: SP-EP-RARP can be safely implemented by a newly graduated fellowship-trained robotic surgeon with acceptable oncologic and functional outcomes. Initial learning can be estimated at approximately 25–30 cases.