Learning Curve of Laparoscopic Radical Prostatectomy Without Mentor Guidance: A Single Surgeon’s Experience Following a 2-Month Observership

Objective: To evaluate the learning curve of a single surgeon performing 72 laparoscopic radical prostatectomy (LRP) cases without mentorship, following a two-month advanced laparoscopy observership. Materials and Methods: The urologist, without prior LRP experience, underwent observership in a high-volume center before independently performing 72 LRP procedures over three years. Cases were divided into two groups: group A (first 36 cases) and group B (subsequent 36 cases). Data on demographics, operative parameters, complications, and surgical outcomes were analyzed. Crucial parameters, including total operation time, lymphadenectomy time, and urethrovesical anastomosis time, were compared between groups. Results: Group B showed significant improvements in total operation time (p=0.008), lymphadenectomy time (p=0.001), and urethrovesical anastomosis time (p<0.001). However, group B, significantly influenced by high-risk cases and a rectal injury complication, had longer hospital stays and urinary catheter durations. Despite a higher rate of high-risk cases in group B, there was no significant difference in overall complication rates or positive surgical margins. One case required conversion to open surgery due to rectal injury. Conclusions: Significant improvements in operative times were observed; however, complication rates and positive surgical margins did not differ significantly between groups, likely influenced by the higher proportion of high-risk patients in the second group. While these findings suggest that LRP can be performed without direct mentorship, the study’s single-surgeon experience and limited sample size restrict generalizability. Longer follow-up and larger studies are needed to assess oncological and functional outcomes and to further optimize the learning curve.