Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

Abstract

To describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.

Single-port and multiport robot-assisted radical prostatectomy: A meta-analysis

“…Published studies have demonstrated that the single-port robotic technique is a safe and feasible approach for performing radical prostatectomy. This is consistent with our reported findings 15 , 23 , 25 , 33 . As compared to the widely accepted MP-RARP, our analysis found that the single-port approach has comparable outcomes, including operation time, estimated blood loss and postoperative complications.…”

Versius robotic surgical system: case series of 18 robot‐assisted radical prostatectomies

“…Operative times and estimated blood loss were consistent with other RARP series using different robotic platforms [25][26][27]. Considering the extensive experience of our surgeon with other robotic platforms; it appears that the knowledge and skills of the RARP procedure, between the different platforms was largely transferable and the learning curve was greatly reduced, and the average blood losses were in fact low in our series.…”

Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes

“…Port placement represents a key point in performing a perineal approach with a multiport robotic platform, as also described by Tuğcu et al [11] . The da Vinci Xi system facilitates this approach by maximizing freedom of movement, minimizing instrument clashing, and providing good ergonomics during the critical steps of the procedure, compared with Si [20] , [21] , [22] . Moreover, we introduced for the first time the AirSeal system as an assistant port.…”