To investigate the surgical learning curve of robotic-assisted radical cystectomy and orthotopic neobladder (RARC/ONB).

The clinical data of 105 RARC/ONB patients consecutively performed by a fixed medical team from March 2017 to March 2023 were retrospectively analyzed. The learning curve of RARC/ONB was analyzed by the cumulative sum (CUSUM) with the operation time as the measurement indicator. The learning stages were divided according to the inflection points of the learning curve. The perioperative data, urodynamic characteristics of the neobladder, and postoperative urinary continence of each stage of the learning curve were compared.

All 105 surgeries were successfully completed, with no cases converted to open surgery. According to CUSUM analysis, the learning curve can be divided into two stages: 59 cases in the learning and growth stage and 46 cases in the advanced mastery stage. In the advanced mastery stage, the patients had less intraoperative blood loss (P<0.001), a lower intraoperative blood transfusion rate (P=0.006), shorter total operation time, internal reconstruction time, postoperative intestinal defecation time, postoperative hospital stay, and the total hospital stay (P<0.001), and a lower incidence of complications within 90 days after surgery (P=0.039). There was no significant difference in the urodynamic data and urinary continence rate of the neobladder in the two stages 6 months after surgery (P>0.05).

RARC/ONB is a safe, effective and repeatable surgical procedure. According to CUSUM analysis, approximately 59 patients are needed to overcome the initial learning and growth stage, which can provide a reference for specialist training and technology promotion.