Evolution of Surgical Efficacy and Postoperative Outcomes of a surgeon Throughout the Learning Curve of Laparoscopic Radical Prostatectomy with limited experience of open surgery

Objective This study aimed to evaluate the learning curve, as well as the oncological and functional outcomes, of a surgeon who initiated laparoscopic radical prostatectomy (LRP) in a low-volume center after limited experience with open radical prostatectomy. Materials and Methods In this retrospective study, 90 patients who underwent LRP were analyzed. For assessing the learning curve, patients were divided chronologically into three groups of 30 each. Demographic data, preoperative prostate specific antigen (PSA), biopsy The international society of urological pathology (ISUP) grade, operative time, intraoperative blood loss, transfusion requirement, length of hospital stay, postoperative catheterization duration, pathological outcomes, and one-year PSA recurrence, continence, and erectile function were evaluated. Results Operative time decreased with experience, reaching a plateau phase after approximately 60 cases (Group 1: 251.3 ± 52.3 min vs. Group 3: 218.7 ± 40.4 min; p = 0.027). Hospital stay also significantly declined with experience (Group 1: 5.5 days vs. Group 3: 4.1 days; p < 0.001). Although a decrease in blood loss was observed, it did not reach statistical significance, and transfusion rates remained minimal (3.3%). The rate of lymph node dissection significantly increased with surgical experience (Group 1: 23.3% vs. Group 3: 56.7%; p = 0.022). No significant differences were observed in early complications or PSA recurrence rates between groups. Erectile function preservation improved from 23.3% in Group 1 to 50.0% in Group 3, whereas continence outcomes remained comparable. Conclusions For surgeons initiating LRP, operative time reaches a plateau after approximately 60 cases, while functional outcomes continue to improve over time. With appropriate training and mentorship, LRP can be safely and effectively performed in low-volume centers with acceptable perioperative and functional results throughout the learning process. Trial registration: Retrospectively registered.