Introduction: The learning curve for retzius sparing robotic radical prostatectomy is not fully understood. This study attempts to identify the learning-curve across the first 130 cases of a single surgeon. Methods: All retzius sparing robotic radical prostatectomy cases performed by a single surgeon between April 2019 and July 2022 were included. Cases were divided chronologically into 3 groups. Results: 130 RS-RARP cases were identified. Statistically significant differences were found between groups in several areas. Median patient age increased between group 1 (59yrs) and Group 3 (66.5yrs) (P=0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) (P=0.036). Median console time increased between Group 1 (120 mins) and Group 2 (150 mins,) (P=0.01). Median gland weight increased between Group 1 (28g) and Group 3 (35.5g) (P<0.001). Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Conclusions: The complexity of cases increased over the learning curve, reflected in older patients, larger prostates and higher stage disease, but the positive surgical margin rate improved with experience. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease.

all authors confirm they have no conflict of interest that are relevant to the content of this article

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of Cambridge University Hospitals NHS Foundation Trust waived ethical approval for this work

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors