Comparison of Surgical Outcomes of Robot-assisted Radical Prostatectomy between Residents under our Training Curriculum and Experienced Surgeons: A Propensity Score-matched Analysis

Abstract Background We developed a robot-assisted training curriculum for urology residents with limited experience in open and laparoscopic surgeries. In this retrospective single-center study, we aimed to evaluate our curriculum by comparing surgical outcomes of robot-assisted radical prostatectomy performed by residents enrolled in the curriculum with those of procedures performed by experienced surgeons. Methods Fifty-three patients whose robot-assisted radical prostatectomy was performed by urology residents were propensity score-matched using clinicopathological characteristics to patients whose robot-assisted radical prostatectomy was performed by experienced surgeons. Surgical and pathological outcomes were compared between groups, including estimated blood loss, operative time, perioperative complication rates, positive surgical margins, and immediate urinary continence. Residents were initially trained in robot-assisted surgery. Our training program included video lectures and dry-laboratory exercises with three-dimensional pelvic models, origami training, and vesicourethral anastomosis simulation. Results Estimated blood loss and complication rates were comparable between groups. Bladder takedown and seminal vesicle dissection significantly prolonged the operative time in the resident group, which was 1.16 times longer (median 249 vs. 213 min; p < 0.001). Notably, vesicourethral anastomosis time was the only procedure with comparable time between groups (17 vs. 14 min; p = 0.082). There were no significant differences in perioperative complication rates, positive surgical margin rates, or immediate urinary continence. Conclusions Trained residents performed robot-assisted radical prostatectomy safely with acceptable surgical outcomes, despite longer operative times. Simulation-based training enables residents to perform procedures within a timeframe comparable to that of experienced surgeons; therefore, well-designed surgical models are needed for training purposes.