Single port robotic radical prostatectomy: a systematic review

Abstract

Several studies have assessed the safety and feasibility of single port robot-assisted radical prostatectomy using different and custom built robotic-assisted technology. In part due to the nonstandardized nature of these approaches, single site robotic prostatectomy has not been widely adopted.With the recent approval of the da Vinci (Intuitive Surgical, Sunnyvale CA) Single Port (SP) platform, there has been a renewed interest in single site robotic-assisted prostatectomy and several institutions have begun reporting their initial experiences with this technique. In this systematic review, we sought to assess and summarize the literature regarding patient outcomes for single site robotic-assisted prostatectomy and evaluate its role in surgical treatment of prostate cancer. This systematic review was structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the use of any robotic platform, including da Vinci Si, Xi or SP platforms for robotic single-port or single site radical prostatectomy between 2000 and July 15, 2019 were eligible for inclusion in this systematic review. Studies were excluded if they included combined cases with other organ resection, represented use in a non-clinical setting (such as a cadaveric model), or described results for a simple prostatectomy technique.Data was extracted by two authors with concerns resolved by consensus. Primary outcomes were mean operative times, estimated blood loss (mL), and hospital length of stay (days). Secondary outcomes included intraoperative conversion to open surgery, and intraoperative and postoperative complications. Variables of interest included sample size (n), mean age (years), mean prostate size (mL), prostate specific antigen (PSA, ng/mL), Gleason score, clinical and pathological TNM staging [American Joint Commission on Cancer (AJCC)], lymph nodes (n) and perioperative complications as available. A total of 217 studies were reviewed by title and abstract, with 28 selected for full-text review; ultimately, 12 studies were included, with available data from 145 patients. Primary outcomes and preoperative characteristics varied greatly amongst patients and across studies. One patient (0.7%) required conversion to a multi-port approach and there were no conversions to an open technique. No intraoperative complications were reported, and no Clavien grade III or greater postoperative complications have been described in the initial 81 radical prostatectomies performed with the SP platform. Single Port techniques appear to represent a safe and feasible approach for performing the minimally invasive radical prostatectomy. The current available literature on the single port radical prostatectomy is weak and consists of single center studies with small sample sizes, short-term follow up and limited functional data. More rigorous multi-center trials with standardized metrics for reporting functional outcomes as well as long-term cancer specific survival are necessary to validate these in...

Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc)

“…Alternative treatments (open or robotic assisted simple prostatectomy(RASP)) for large glands (≥175mL) are associated with prolonged length of stay (LOS) and postoperative catheterization 3 . Despite technology (robotic platform) and technique advances (retropubic, transvesical, singleport) in the management of large gland simple prostatectomy, the majority remain overnight with average LOS ranging 1.05-5 days and catheterization 3.5-8.1 days [4][5][6][7] .…”

Initial experience of single-port robot-assisted radical prostatectomy: A single surgeon's experience with technique description

“… 8 After receiving approval from the US Food and Drug Administration (FDA), various case series have reported the intraoperative and early functional outcomes of SP-RARP. 10 , 11 , 12 …”

Measuring Quality of Life Following Robot-Assisted Radical Prostatectomy

“…78 Lastly, with the release of newer robotics surgery platforms such as the da Vinci Single Port (SP) or Senhance robotic platform (TransEnterix Surgical Inc., Morrisville, NC, USA), surgeons may have additional options outside of the multi-port DaVinci platform currently dominating the market, but the potential benefits and costs will need to be explored prior to widespread implementation. 5,6,[79][80][81][82] These new directions promise to expand the utilization, reliability and widespread applicability of PRO as a critical tool for preoperative counseling and assessing postoperative outcomes following RARP.…”