Robot‐assisted single‐port radical prostatectomy: A phase 1 clinical study

Ng, Chi‐Fai; Teoh, Jeremy Yuen‐Chun; Chiu, Peter Ka‐Fung; Yee, Chi‐Hang; Chan, Connie; Hou, See‐Ming; Kaouk, Jihad; Chan, Eddie Shu‐Yin

doi:10.1111/iju.14044

Cited by 37 publications

(24 citation statements)

References 23 publications

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“…We recently summarized a published series of SP-RARP as shown in Table 3, and our series showed comparable operative time and EBL [6,11,13,14]. There were no major operative complications or open conversion during SP-RARP in either the previous reports or our series, indicating that SP-RARP is a safe procedure.…”

Section: Discussionsupporting

confidence: 61%

Single-port robot-assisted radical prostatectomy with the da Vinci SP system: A single surgeon's experience

et al. 2020

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Purpose: To report an initial single-surgeon experience with single-port robot-assisted radical prostatectomy (SP-RARP) using the da Vinci SP surgical system (Intuitive Surgical, USA). Materials and Methods: Between December 2018 and October 2019, a single surgeon performed SP-RARP in 20 patients with prostate cancer. SP-RARP was performed using the conventional approach through an umbilical port with a GelPOINT access system (Applied Medical, USA) and an additional assist port. During surgery, the camera was placed in the 6-or 12-o'clock position, and a traction arm was placed in the counterpart position for upward or downward traction. Clinicopathologic data, perioperative data, and short-term surgical outcomes were analyzed. Results: Of 20 patients, 45% of patients had pT3 or greater disease and 45% had Gleason grade 4 to 5, respectively. In 11 patients that underwent lymph node dissection, the median number of lymph nodes removed was 19 (interquartile range [IQR], 14-22). Median operative time was 245 minutes (IQR,, and median console time was 190 minutes (IQR,. Median blood loss was 200 mL (IQR, 150-300 mL), and there were no intraoperative complications or open conversion. In 10 patients with a follow-up period longer than 3 months, one patient experienced biochemical recurrence, and all patients required 0 to 1 pads per day. Of seven patients that were potent before surgery, four recovered erectile function sufficient for intercourse. Conclusions: Our report shows the safety and feasibility of SP-RARP, and that the associated surgical outcomes with short-term follow-up are satisfactory.

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Section: Discussionsupporting

confidence: 61%

Single-port robot-assisted radical prostatectomy with the da Vinci SP system: A single surgeon's experience

et al. 2020

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“…While prior surgical robots adopted a similar configuration utilizing multiple ports and rigid laparoscopic instruments, the SP system represents a more significant departure from prior multiport (MP) platforms with a single robotic trocar and flexible articulating camera and instruments [5]. Early investigations have demonstrated the utility of the SP platform across a variety of surgical operations including prostatectomy [6][7][8][9], partial nephrectomy [10], pyeloplasty [11], vaginoplasty [12] and ureteral re-implantation [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…The new robot has just recently been released in the USA for urological use and is a potentially revolutionary technology. The first published studies using the da Vinci SP system were in the cadaveric model describing the feasibility of different types of urological procedures performed by a SP platform called 'SP1098' [11][12][13][14]. These initial reports provided optimism for SP technology and this has evolved into the platform we have today.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

et al. 2020

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To describe the crucial factors related to the implementation of the da Vinci single-port (SP) system (Intuitive Surgical Inc., Sunnyvale, CA, USA), and the early outcomes after the introduction of this robot for robot-assisted radical prostatectomy (RARP). Patients and methods We prospectively collected data from 50 consecutive patients with prostate adenocarcinoma who underwent RARP using this robot. The median follow-up was 53 days. We performed a transperitoneal technique. The robotic (multiport) trocar was placed on the supra-umbilical midline 20 cm from the pubis and an assistant trocar placed in the right lower quadrant. We report our initial experience describing the intra-and postoperative outcomes associated with this new robot. Also, we report the early functional and oncological outcomes in the follow-up period considered. Continuous variables were described as medians and interquartile ranges, while categorical variables as frequencies and proportions. Results The median total operative time was 118 min, median console time was 80 min, and median estimated blood loss was 50 mL. There were no intraoperative complications or blood transfusions. The final pathology reported 18% Grade Group (GrGp)1, 58% GrGp2, 18% GrGp3, 2% GrGp4, and 4% GrGp5. In all, 40 patients (80%) were pT2 and 20% were ≥pT3a. The overall positive surgical margin rate was 14%. In all, 39 patients (78%) achieved full continence at median of 21 days after RARP. The median pain scale (0-10) score at 8, 12 and 16 h after RARP was 2, 2, and 0, respectively. Conclusion The use of the da Vinci SP robot with an additional assistant port for RARP is technically safe and feasible, with acceptable short-term functional and oncological outcomes. However, there is a technical learning curve for this new platform due to the smaller scope of the operative field and the decreased flexibility and strength of the surgical instruments.

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Robot‐assisted single‐port radical prostatectomy: A phase 1 clinical study

Cited by 37 publications

References 23 publications

Single-port robot-assisted radical prostatectomy with the da Vinci SP system: A single surgeon's experience

Single-port robot-assisted radical prostatectomy with the da Vinci SP system: A single surgeon's experience

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

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

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