Robot-Assisted Radical Prostatectomy as the Institutional Standard: Complete Transition and Contemporary Outcomes from a High-Volume European Center

Background: Robot-assisted radical prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in high-volume centers worldwide. However, comprehensive real-world data describing complete institutional transition from open to robotic surgery remain limited. This study evaluated perioperative and early oncological outcomes of a contemporary RARP cohort and characterized the transition from open radical prostatectomy (ORP) to RARP in a European center. Methods: We analyzed 520 consecutive patients who underwent RARP between January 2023 and December 2025. Perioperative, pathological, and biochemical outcomes were assessed. Biochemical recurrence was defined as prostate-specific antigen ≥0.2 ng/mL. Institutional data from 2011 to 2025 were reviewed to evaluate procedural trends and the transition from ORP to RARP. Surgeon-specific and institutional learning curves were analyzed using operative time and linear regression models. Results: Following the introduction of robotic surgery in 2018, annual RARP volume increased from 37 procedures to 205 in 2025. Since 2023, RARP accounted for more than 99% of all radical prostatectomies. Median operative time decreased from 185 min in 2023 to 165 min in 2025, with consistent downward trends observed across all surgeons. Linear regression confirmed progressive improvement in operative efficiency, with learning rates ranging from −0.22 to −0.92 min per case. Estimated blood loss was minimal, no patients required transfusion, and major complications occurred in four patients (0.8%). Hospital stay decreased from 2 days to predominantly 1 day. During follow-up, 36 patients developed biochemical recurrence or PSA persistence. Biochemical recurrence-free survival differed significantly according to pathological stage (log-rank p < 0.001), with 24-month estimates of 93.7%, 91.5%, and 82.1% for pT2, pT3a, and pT3b disease, respectively. Conclusions: RARP provides favorable perioperative safety, minimal morbidity, and favorable early oncological outcomes in a high-volume setting. The complete institutional transition from ORP to RARP, together with demonstrated surgeon-specific and institutional learning effects, supports the feasibility and safety of implementing RARP as the institutional standard within a structured robotic program.