Da Vinci SP radical prostatectomy: a multicentric collaboration and step-by-step techniques

Abstract

_______________________________________________________________________________________Introduction: Several techniques of robotic-assisted radical prostatectomy (RARP) using the da Vinci SP (SP) have been described since its clearance by the FDA (Food and Drug Administration) in 2018 (1, 2). Even with the expanding literature about this robot, the SP technology has been restricted to a few centers in the US and Asia due to the recent release of this robot in the marked.3 In this scenario, we provided, in this video compilation, a consensus of SP referral centers describing the current approaches and techniques of da Vinci SP Radical prostatectomy (SP-RARP). Surgical Technique: We have illustrated five different techniques, including transperitoneal, extraperitoneal, Retziussparing, transvesical, and transperineal (4-6). Each surgery demonstrated crucial steps from the trocar placement until anastomosis. All approaches follow anatomic concepts and landmarks to minimize positive surgical margins, optimize oncological outcomes and promote optimal functional recovery. The trocar placement and the use of an assistant port were selected according to the operative technique of each institution. None of these surgeries had intra-or postoperative complications, and the pain management until discharge was controlled without using narcotics. All patients were discharged in less than 16 hours of surgery. Conclusion: Robotic-assisted radical prostatectomy performed with the da Vinci SP is feasible and safe with optimal perioperative outcomes. Five different approaches were described in this video compilation, and we believe that the technical details provided by this multicentric collaboration are crucial for centers willing to initiate the SP approach to radical prostatectomy.

Comparison between intra- and postoperative outcomes of the da Vinci SP and da Vinci Xi robotic platforms in patients undergoing radical prostatectomy

“…However, we believe that the current generation SP is not a robot to replace the multiport Xi but to complement its use in patients who are not candidates for the multiport approach, such as patients with ileostomy, colostomy, penile prosthesis with reservoir, kidney transplants, and other intra-abdominal obstacles. 27 Recently, some authors have described the transvesical access that can further expand the use of SP in these patients with a hostile abdomen.. 20,21,28 However, the functional and oncological results of this technique are still under discussion.…”

“…We also used transperitoneal access with an anterior approach, as described by previous studies performed at our institution. 3,[15][16][17][18][19][20][21] None of the groups had abdominal drains placed after the procedure.…”

Complications of single‐port robot‐assisted radical prostatectomy: multi‐institutional analysis from the Single‐Port Advanced Research Consortium (SPARC)

“…All procedures were completed using the purpose-built SP robotic platform with all double-articulating instruments, camera, and the remotely operated suction irrigation (ROSI) system (Vascular Technology Inc. [VTI], Nashua, NH, USA) inserted through a multichannel cannula of the dedicated SP Access Kit (Intuitive Surgical Inc.). The individual surgical techniques for the three approaches have been described previously [3][4][5]. In the novel TV approach, direct entry into the bladder was obtained via a suprapubic incision.…”

“…The narrow profile of the robot and the double-articulating instruments have been shown to offer improved manoeuvrability, especially in smaller surgical working space [2]. As such, in addition to its application for conventional techniques, such as transperitoneal (TP) and extraperitoneal (EP) approaches, the distinguishing features of the SP platform provided the opportunity for surgeons to regionalise RARP to the relevant anatomy, such as with the conception of the transvesical (TV) approach [3][4][5].…”

Selection of best videos of the year for 2022

“…In making the selection of best videos of the year, several criteria have been employed including their surgical novelty and potential to improve patient care. These are clearly high bars set but truthfully I am thrilled to report that these challenging criteria have been achieved to a large extent by many of our published videos so all contributing authors of accepted videos over the past year are to be congratulated nevertheless there can only be a few select winners and on that note, I am pleased to announce that the first prize for best video of the year is awarded to the submission by Moschovas MC et al entitled “Da Vinci SP radical prostatectomy: A multicentric collaboration and step-by-step techniques” published in the July-August issue (Vol 48(4):728-729) of our journal ( 1 ). The video provides a very practical approach to conducting minimally invasive radical prostatectomy using a single port platform as defined by some of the premier global surgical leaders in this milieu.…”