What's known on the subject? and What does the study add? We have earlier proposed ‘pentafecta’ as an ideal outcome assessment tool after robotic prostatectomy instead of the classically used ‘tritecta’. This was done to meet the demands and expectations of the prostate cancer patients from minimally‐invasive surgical techniques. This article reviews each of the five arms of ‘pentafecta’ outcomes after robotic prostatectomy performed in high volume centres. Historically, the ideal outcome of radical prostatectomy (RP) has been measured by achievement of the so‐called ‘trifecta’, or the concurrent attainment of continence and potency with no evidence of biochemical recurrence. However, in the PSA era, younger and healthier men are more frequently diagnosed with prostate cancer. Such patients have higher expectations from the advanced minimally invasive surgical technologies. Mere trifecta is no longer an ideal outcome measure to meet the demands of such patients. Keeping the limitations of trifecta in mind, we have earlier proposed a new method of outcomes analysis, called the ‘pentafecta’, which adds early complications and positive surgical margins (PSMs) to trifecta. We performed a Medline search for articles reporting the complications, PSM rates, continence, potency and biochemical recurrence after robot‐assisted RP. Related articles were selected and individual outcomes were reviewed.

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Objective To describe our technique of extraperitoneal single‐port (SP) robot‐assisted radical prostatectomy (RARP) and present our clinical experience with the first 10 cases. Patients and Methods In all, 10 consecutive patients diagnosed with localised prostate cancer underwent extraperitoneal SP‐RARP using the da Vinci SP® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Exclusion criteria included previous surgery through an infra‐umbilical midline incision, prostate size >100 g, or preoperative evidence of extraprostatic disease. All surgeries were performed by a single surgeon with previous experience of >3000 cases in robotic surgery. Demographics and perioperative information were collected including: operative time, estimated blood loss (EBL), complications, length of stay, and days with Foley catheter. The extraperitoneal SP‐RARP is performed as follows. Firstly, a 3‐cm incision ~2 cm below the umbilicus is made. Dissection of the extraperitoneal space is achieved using a kidney shaped Spacemaker™ balloon (Covidien, Dublin, Ireland), placed through the infra‐umbilical incision caudally reaching the retropubic space. Thereafter, the balloon is deployed; the space is created and verified under direct vision with a laparoscopic endoscope. A GelPOINT® mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) is inserted and a dedicated 25‐mm multichannel port is placed with a 12‐mm accessory laparoscopic port through the gel‐seal cap into the same incision. The da Vinci SP surgical platform robot is docked with the patient in a supine position. RARP is performed replicating the technique previously described for multi‐arm platforms or transperitoneal SP‐RARP. No drain and no additional assistant ports were utilised. Results The patient's ages ranged between 48 and 70 years, and the mean preoperative prostate‐specific antigen (PSA) level was 9 ng/mL. No conversions or intraoperative complications were recorded. The median (interquartile range) operative time was 197.5 (185.5–229.7) min. EBL ranged between 50 and 400 mL, six patients were discharged on the same day as the surgery and the median time with a Foley catheter after surgery was 8 days. Conclusions Extraperitoneal SP‐RARP is a feasible and safe surgical option to treat localised prostate cancer. In our early experience, promising results and possible advantages were found such as: a small single incision, no additional ports, no Trendelenburg positioning, minimal postoperative pain and use of opioids, and same day discharge. Further investigations need to be done to validate these advantages.

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