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

Abstract

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.

Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy

“…Notably, cases performed with the SP platform were associated with decreased median lymph node yields. Both values are lower than previously reported lymph node yields for both SP as well as RS-RALP with median values of 19 and 15 lymph nodes, respectively [ 7 , 24 ]. A potential reason for this is that our group detected high rates of symptomatic lymphoceles early on in our experience with RS-RALP [ 15 ].…”

Single-port robot-assisted radical prostatectomy

“…of days : 1 = 37 (94.9%) 2 = 2 (5.1%) Clavien ≥ 2 = 2 (5.1%) Kim et al . (2020) [ 14 ] 20 245 (200–255) 200 (150–300) 0 (0%) 11 (55%) 0 (0%) 0 (0%) 7 days (4–8) Clavien ≥ 2 = 0 (0%) Jones et al . (2020) [ 13 ] 23 236 (191–343) 50 (20–500) 0 (0%) 12 (52.2%) 0 (0%) 1 (4.3%) 1 day (range, 1–6) Clavien ≥ 2 = 6 (26.1%) Abaza et al .…”

Preliminary comparison of the modified extraperitoneal free-PORT single incision technique and transabdominal multi-incision robot-assisted laparoscopic radical prostatectomy

“…The latest research results show that there is no significant difference in perioperative and pathological results between single-incision RARP and standard laparoscopic multiple-incision RARP. Some studies have reported that single-incision surgery may have more advantages in the recovery of postoperative erectile function [12][13][14] , but there are also reports that single-incision surgery takes a longer time because of the establishment of space 15,16 . This is because although the robot system multijoint instrument arm and simulated wrist instrument improve the problem of too narrow operation space to some extent, the collision between robotic arms will still occur during placement of a slightly large free suture, which also makes it more difficult for assistants to cooperate.…”