Robotic vs laparoscopic radical prostatectomy: the impact of surgeon volume on surgical margins and quality of life.

BACKGROUND: The principal established therapeutic option for localized prostate cancer is the robotic-assisted radical prostatectomy (RARP) over the laparoscopic radical prostatectomy (LRP). Robust data from Chinese hospitals is limited, and the effect of surgeon experience is often overlooked. OBJECTIVE: This study retrospectively compares outcomes between RARP and LRP, evaluating the impact of surgeon experience. METHODS: The clinical information of 252 patients who underwent RARP or LRP between 2019 and 2023 was retrospectively analysed. Multivariable regression models, for both patient characteristics and surgeon volume, were employed to evaluate perioperative metrics, complications, positive surgical margins (PSM), continence, and patient-reported outcomes. RESULTS: RARP demonstrated superior advantages, including a shorter operative time (154.9±28.3 vs. 169.2±23.9 minutes, P<0.001), less blood loss (172.5±56.8 vs. 306.8±82.2 mL, P<0.001), and a shorter hospital stay (2.3 vs. 3.9 days, P<0.001). Multivariable analysis revealed that both surgical approaches and surgeon volume were predictors of outcomes: 66% lower odds of PSM (OR: 0.34, P=0.009) in the RARP group, while high-volume surgeons demonstrated 96% lower odds of PSM compared to low-volume surgeons (OR: 0.039, P<0.001). RARP patients experienced fewer complications (25.4% vs. 39.7%, P=0.016) and a higher continence recovery at 12 months (95.2% vs. 80.2%, P=0.001). Regarding patient-reported outcomes, RARP was consistently favored across all domains (P<0.01). CONCLUSION: While preserving comparable functional and short-period cancer-related outcomes, RARP outperformed LRP in perioperative outcomes and patients' quality of life. These findings demonstrate that both surgical technology and surgeon volume are critical, independent determinants of surgical quality. The optimal outcomes are achieved by pairing advanced robotic technology with high-volume surgical expertise.