ORIGINAL ARTICLE Specific learning curve for port placement and docking of da Vinci Ò Surgical System: one surgeon’s experience in robotic-assisted radical prostatectomy F. Dal Moro • S. Secco • C. Valotto • W. Artibani • F. Zattoni Received: 15 May 2011 / Accepted: 12 September 2011 Ó Springer-Verlag London Ltd 2011 Abstract Port placement and docking of the da Vinci Ò Surgical System is fundamental in robotic-assisted lapa- roscopic radical prostatectomy (RALP). The aim of our study was to investigate learning curves for port placement and docking of robots (PPDR) in RALP. This manuscript is a retrospective review of prospectively collected data looking at PPDR in 526 patients who underwent RALP in our institute from April 2005 to May 2010. Data included patient-factor features such as body mass index (BMI), and pre-, intra- and post-operative data. Intra-operative infor- mation included operation time, subdivided into anesthesia, PPDR and console times. 526 patients underwent RALP, but only those in whom PPDR was performed by the same surgeon without laparoscopic and robotic experience (F.D.M.) were studied, totalling 257 cases. The PPDR phase revealed an evident learning curve, comparable with other robotic phases. Efficiency improved until approxi- mately the 60th case (P \ 0.001), due more to effective port placement than to docking of robotic arms. In our experience, conversion to open surgery is so rare that sta- tistical evaluation is not significant. Conversion due to robotic device failure is also very rare. This study on da Vinci procedures in RALP revealed a learning curve during PPDR and throughout the robotic-assisted procedure, reaching a plateau after 60 cases. Keywords Robot docking Á Learning curve Á PPDR Á RALP Á Robotic-assisted laparoscopic radical prostatectomy Introduction Radical prostatectomy (RP) is recognized as the standard treatment for localized prostate cancer [1]. In the last few decades, the popularity of laparoscopic and robotic-assisted approaches in treating this malignant disease has increased enormously [2]. Surgical robots were introduced into clinical practice in the late 1990s, to overcome the limi- tations of conventional laparoscopy, and Binder and Kra- mer performed the first robotic-assisted laparoscopic radical prostatectomy (RALP) in May 2000 [3]. Despite the lack of randomized clinical trials, there is reasonable evi- dence that robotic-assisted surgery presents surgeons with several advantages when compared with standard laparos- copy [4, 5], and initial results have highlighted potential benefits such as shorter hospital stay, less pain, and better post-operative functional results [6–10]. As with any new device or technology, an initial learning curve must be overcome in order to achieve competence and expertise [11]. Although this learning curve has repeatedly been described in laparoscopy, it has not been well defined for robotic-assisted surgery [12–14]. Robotic-assisted surgery has generally been considered to have a shorter learning curve than laparoscopic surgery [15]. The former permits expert laparoscopists (including operations of complex bimanual manipulation, suturing and knot-tying) to perform advanced surgical procedures more easily. However, robotic-assisted systems have now made such procedures accessible even to surgeons without advanced video-endoscopic training [16]. F. Dal Moro Á S. Secco (&) Á C. Valotto Á F. Zattoni Urology Clinic, Department of Oncological and Surgical Sciences, University of Padova, via Giustiniani 2, 35128 Padova, Italy e-mail: silviasecc@gmail.com W. Artibani Department of Urology, University of Verona, Verona, Italy 123 J Robotic Surg DOI 10.1007/s11701-011-0315-2