Adoption of Single-Port Robot-Assisted Radical Prostatectomy Following Multiport Xi Experience: Lessons from a Learning Curve Analysis

In the operating room, a surgeon once relied on a robotic system that required several small incisions to guide its instruments. This multi-port approach, using a platform known as Xi, had become the standard for removing the prostate gland in men with cancer, offering precision and excellent results. However, a newer technology emerged: a single-port system. This device is designed to perform the same complex surgery through just one small opening, theoretically reducing trauma and scarring even further. The question facing surgeons who had already mastered the older, multi-incision method was whether their hard-won skills would translate to this new, streamlined tool, or if they would have to start over from scratch.

This question is not merely about convenience; it touches on the efficiency of patient care and the safety of adopting new medical technologies. If a surgeon must relearn the entire procedure from the beginning when switching platforms, the transition could be slow and risky for early patients. If, however, the core skills of robotic surgery are transferable, a surgeon could adopt the new single-port system with confidence, maintaining high standards of care from the very first case. A team of researchers at Inha University College of Medicine set out to answer this by watching a single surgeon navigate this exact transition. They compared the surgeon's first hundred operations using the older multi-port robot with the first hundred operations using the new single-port robot, tracking how long the surgeries took and how well they went.

The researchers found that the surgeon's previous experience with the multi-port robot acted as a powerful foundation. When the surgeon began using the single-port system, the operations were already fast and efficient. The time the surgeon spent controlling the robot from the console was significantly shorter in the single-port group, averaging 67 minutes, compared to 97.5 minutes in the earlier multi-port group. The total time the patient spent in the operating room was also much shorter, dropping from 145 minutes to 95 minutes. This speed was not a gradual improvement that took years to achieve; it was present from the very start of the single-port experience.

To understand how the surgeon's skill evolved, the team looked at the pattern of these times across the hundred cases. In the first hundred multi-port surgeries, the surgeon's time decreased sharply as they learned the ropes, reaching a point of stability after about 23 cases. In the single-port group, the time remained relatively steady and low throughout, with the point of stability appearing later, around the 57th case. The researchers explain that this later point does not mean the surgeon struggled more with the new system. Instead, it suggests that the surgeon was already so proficient from their prior experience that the new system required only fine-tuning rather than a complete relearning of the basics. The surgeon was refining an already mastered technique rather than climbing a steep learning curve from the bottom.

The study also examined the safety and success of the surgeries. The rate of complications, such as emergency room visits or hospital readmissions within 30 days, was similar between the two groups. The researchers also looked at whether the cancer was completely removed, a critical measure of success. Overall, the single-port group had a lower rate of cancer cells left at the edge of the removed tissue, but the researchers noted this was likely due to the surgeon's growing experience over time and differences in which patients were selected for each group, rather than the new machine being inherently superior. When they looked at patients with the same stage of cancer, the success rates were comparable between the two systems.

One notable difference in how the surgeries were performed involved the removal of lymph nodes, which is sometimes necessary to check if cancer has spread. The surgeon performed this step in nearly 30 percent of the multi-port cases but in only 1 percent of the single-port cases. This was a deliberate choice based on the surgical strategy at the time. The single-port system was used primarily for patients who did not need lymph node removal, as the approach for removing nodes with this specific robot was more complex and time-consuming. For patients who did need it, the surgeon used a different approach entirely. This strategic difference meant the single-port surgeries were faster, but it also highlights that the choice of tool depends on the specific needs of the patient.

The findings suggest that robotic surgical skill is not tied to a single machine but is a transferable ability. A surgeon who has mastered the multi-port robot can move to the single-port system without losing efficiency or safety. The two systems appear to be complementary rather than competitors. The older multi-port robot remains a robust tool for complex cases requiring extensive dissection, while the newer single-port system offers a streamlined option for patients who do not need that level of intervention. For the medical community, this means that adopting new, less invasive technologies does not require abandoning previous expertise. Instead, a surgeon's accumulated experience can serve as a bridge, allowing them to offer the latest advancements to their patients immediately and effectively.