441 JOURNAL OF ENDOUROLOGY Volume 21, Number 4, April 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2006.0239 Robotic Radical Prostatectomy Learning Curve of a Fellowship-Trained Laparoscopic Surgeon KEVIN C. ZORN, M.D., MARCELO A. ORVIETO, M.D., EDWARD M. GONG, M.D., ALBERT A. MIKHAIL, M.D., OFER N. GOFRIT, M.D., GREGORY P. ZAGAJA, M.D., and ARIEH L. SHALHAV, M.D. ABSTRACT Background and Purpose: Several experienced practitioners of open surgery with limited or no laparoscopic background have adopted robot-assisted laparoscopic radical prostatectomy (RLRP) as an alternative to open radical prostatectomy (RRP), demonstrating outcomes comparable to those in large RRP and laparoscopic prostatectomy series. Thus, the significance of prior laparoscopic skills seems unclear. The learning curve, with respect to operative time and complications, in the hands of a devoted laparoscopic surgeon has not been critically assessed. We evaluated the learning curve of a highly experienced laparoscopic surgeon in achiev- ing expertise with RLRP. Patients and Methods: We prospectively evaluated 150 consecutive patients undergoing RLRP by a single surgeon between March 2003 and September 2005. The first 25 cases were performed with the assistance of a surgeon experienced in open RRP. Data were compared for the first, second, and third groups of 50 cases. Demographic data were similar for the three groups. Urinary and sexual function data were evaluated sub- jectively and objectively using the RAND-36v2 Survey and the UCLA PCI preoperatively and at 3, 6, and 12 months postoperatively. Results: The mean operative time, blood loss, and conversion rate decreased significantly with increasing experience. All open conversions occurred during the first 25 cases. Intraoperative and postoperative com- plication rates were similar among groups. Although the differences were not significant, urinary and sexual function recovery improved with experience. Conclusion: The RLRP learning curve for a fellowship-trained laparoscopic surgeon seems to be similar to that of laparoscopically naive yet experienced practitioners of open RRP. The RLRP is safe and reproducible and even during the learning curve can produce results similar to those reported in large RRP series. The importance of assistance by an experienced open RRP surgeon during the learning curve cannot be overemphasized. INTRODUCTION R OBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RLRP), as an alternative treatment for localized prostate cancer, has gained widespread accep- tance in the United States in recent years. 1 The RLRP pro- vides the benefits of minimally invasive surgery, while it has the potential to shorten the steep learning curve observed with standard laparoscopic radical prostatectomy (LRP). 2,3 The learning curve has been estimated by several laparoscopic sur- geons to be 50 LRPs. 4 Indeed, RLRP offers remarkable tech- nical advantages over LRP such as magnified three-dimen- sional vision, greater range of instrument motion, and minimization of tremor. 2 The significant ease observed with the da Vinci system compared with LRP has encouraged lap- aroscopy-naïve surgeons experienced with open radical retropubic prostatectomy (RRP) to adopt RLRP. 2,3,5 These se- ries have achieved cancer-control and functional outcomes similar to those in large LRP series published previously. 6,7 Thus, the significance of having laparoscopic skills prior to performing RLRP appears to be minor. On the other hand, the RLRP learning curve in the hands of a devoted laparoscopic surgeon has not been assessed critically. We prospectively evaluated the learning curve, based on operative time and complication rate, of a highly experienced laparoscopic sur- geon in achieving expertise with RLRP. Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois.