Abstract
Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.
Highlights
In 1992, Schuessler et al [1] firstly reported their experience with laparoscopic radical prostatectomy (RP)
Less than a decade after its first use, over 80% of RPs were performed with this platform in 2008 in the United States [4]
We presented ourbeen experience of our study,are were discharged home until the Foley catheter had removed, single sitefelt plus twohad additional ports to perform robot-assisted RP (RARP) [13]
Summary
The development of articulated and flexible instruments provided the proper platform for triangulation through a single port incision [5]. Based on this ‘Y’ principle concept of the second robotic assist single site platform, a new ‘plate spring mechanism’ was introduced. Dobbs et al [9] noted that the robotic surgical platform has led to a dramatic change in the availability and utilization of laparoscopic surgery. It is associated with favorable perioperative outcomes, but significantly greater fixed costs of instrumentation and ongoing equipment expenses. This problem discourages surgeons to perform LESS-RP using the SP system
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