Single-port Radical Prostatectomy Research Articles

Single Port Radical Prostatectomy as a Viable Option for Highly Complex Patients: A Single Center Experience

ObjectiveTo explore the safety and feasibility of the Da Vinci® Single-Port (SP) platform in Robotic-Assisted Radical Prostatectomy (SP-RARP), aiming to provide a viable option for patients with surgical and medical complexities that might otherwise limit their access to common minimally invasive technique. MethodsData from 60 medically and surgically highly complex patients undergoing SP-RARP between December 2018 and December 2023 were analyzed. Variables included patient characteristics, surgical history, intraoperative and postoperative outcomes. Statistical analysis was conducted using Stata® 17.0. ResultsFifty-three percent of cases had a hostile abdomen (HA) (≥1 major abdominal surgery), and 47% were medically highly complex (American Society of Anesthesiologists score ≥3, Charlson Comorbidity Index ≥5 and a Body Mass Index ≥30). The extraperitoneal approach was used in 56% of HA cases and 68% of MHC cases. Intraoperative complications occurred in 12%, exclusively with the transperitoneal approach in HA cases. Postoperative complications (Clavien Dindo ≥3) were 6% and 14%, respectively, with no significant difference between approaches. Same-day discharge was possible in 44% of HA cases and 54% of MHC cases, with significant statistical differences favoring the extraperitoneal approach in both groups. ConclusionSP-RARP, particularly the extraperitoneal approach, is a viable option for highly complex and challenging cases, providing acceptable oncological and functional outcomes. Prospective studies are crucial for further validating the safety and feasibility of SP-RARP in this patient population.

PD27-06 SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 1,100 CONSECUTIVE PATIENTS FROM THE MULTI-INSTITUTIONAL SPARC COLLABORATION

You have accessJournal of UrologyCME1 Apr 2023PD27-06 SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 1,100 CONSECUTIVE PATIENTS FROM THE MULTI-INSTITUTIONAL SPARC COLLABORATION Ethan Ferguson, Roxana Ramos, Graham Hale, Jennifer Nguyen, Marcio Moschovas, Samantha Wilder, Kennedy Okhawere, Ruth Sanchez De La Rosa, Alp Tuna Beksac, Indu Saini, James Peabody, Ketan K. Badani, Craig Rogers, Jean Joseph, Vipul Patel, Michael Stifelman, Jeffrey Nix, Moses Kim, Mutahar Ahmed, Simone Crivellaro, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Graham HaleGraham Hale More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Indu SainiIndu Saini More articles by this author , James PeabodyJames Peabody More articles by this author , Ketan K. BadaniKetan K. Badani More articles by this author , Craig RogersCraig Rogers More articles by this author , Jean JosephJean Joseph More articles by this author , Vipul PatelVipul Patel More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , Moses KimMoses Kim More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy using the single-port (SP) robotic platform has been performed using a variety of surgical approaches. We sought to report the outcomes of a large multi-institutional series and compare techniques. METHODS: From 2/2019 to 10/2022, SP robotic radical prostatectomy was performed in 1,103 patients by experienced robotic surgeons at nine institutions from the SPARC collaboration. Perioperative data and early postoperative outcomes were collected prospectively and analyzed retrospectively. RESULTS: SP radical prostatectomy was performed using transperitoneal (TP, n=244), extraperitoneal (EP, n=712), and transvesical (TV, n=147) approaches. All procedures were completed successfully without intraoperative complications or open conversion. About 30% of all patients had a history of prior abdominal surgery, with significant differences noted based on operative technique; 50% TV, 30% EP, and 3% TP. The EP approach was associated with higher NCCN risk and biopsy Gleason scores, as well as a higher lymph node yield than in other approaches. Opioid were prescribed in 20% and pain scores at discharge were low for all patients. Significant differences were identified in postoperative parameters including the performance of lymphadenectomy, inpatient hospital stay, and foley catheter duration. The TV approach was associated with a lower rate of positive margins (18.2%) compared with EP (30.2%) and TP (30.1%). Follow up duration for the entire series was 10.8 months. CONCLUSIONS: We reported the outcomes of a large series of single-port radical prostatectomy with promising short hospital stay and pain scores. Compared with other techniques, the transvesical approach is associated with shorter length of stay, faster time to continence, and a lower rate of positive surgical margins. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e743 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Graham Hale More articles by this author Jennifer Nguyen More articles by this author Marcio Moschovas More articles by this author Samantha Wilder More articles by this author Kennedy Okhawere More articles by this author Ruth Sanchez De La Rosa More articles by this author Alp Tuna Beksac More articles by this author Indu Saini More articles by this author James Peabody More articles by this author Ketan K. Badani More articles by this author Craig Rogers More articles by this author Jean Joseph More articles by this author Vipul Patel More articles by this author Michael Stifelman More articles by this author Jeffrey Nix More articles by this author Moses Kim More articles by this author Mutahar Ahmed More articles by this author Simone Crivellaro More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

Short term pathologic outcomes and biochemical recurrence rates of single port transvesical retzius-sparing radical prostatectomy as compared to multiport radical prostatectomy.

369 Background: Single port radical prostatectomy with a transvesical Retzius-sparing approach (SPRP) has shown technical feasibility and early evidence of improved time to urinary continence. How this novel approach leads to differences in pathologic outcomes and biochemical recurrence rates (BCR) as compared to multiport radical prostatectomy (MPRP) has yet to be investigated. Our goal was thus to study the pathologic and short term survival outcomes of patients undergoing SPRP as compared to those undergoing MPRP. Methods: Single center, single surgeon retrospective review of prospectively collected data on 169 patients with low and intermediate risk prostate cancer, whom either underwent SPRP or MRPR (2017-2022). Preoperative clinicopathologic and radiographic characteristics were compared. Following RP, pathologic outcomes, including T stage, grade group (GG), margin status, extraprostatic extension (EPE), seminal vesical invasion (SVI), node retrieval rates, lymph node invasion (LNI) and other adverse histopathologic features were compared between both groups. Cox proportional hazards univariate analysis was used to evaluate the impact of SPRP on biochemical recurrence free survival as compared to MPRP with a three year follow up. Results: A total of 84 patients underwent MPRP and 85 patients underwent SPRP. The SPRP cohort had a higher proportion of clinical T stage one as compared to the MPRP cohort (99% vs 85%, p=0.04), however both groups did not differ preoperatively in terms of median total PSA (6.9 MPRP vs 6.2 SPRP, p=0.24), PI-RADS score (p=0.60) or biopsy GG (p=0.52). Following RP, both groups had similar pathologic outcomes including final grade group, T stage, EPE rates, SVI and Cribriform/intraductal rates (p>0.05). SPRP did yield a lower median number of nodes as compared to MPRP (2 (0-5) vs 6(4-9), p<0.001), but this did not translate to differences in LNI (p=0.08). At a median of approximately 12 months of follow up, there were no differences in the biochemical recurrence-free survival rates among both groups (p=0.38). Cox proportional hazards univariate analysis did not consider SPRP to be an independent predictor of biochemical recurrence (HR 0.53, 95% CI 0.13-2.23, p=0.39). Conclusions: In well selected men, SPRP yields similar short term oncologic control as MPRP with equal rates of margin status, EPE/SVI invasion rates and rates of biochemical recurrence at 1 year. In this small, early, single surgeon experience, SPRP appears to be oncologically safe for low and intermediate risk prostate cancer patients, however longer follow up is necessary, larger numbers and multi- institutional comparisons are needed.

Single port robotic radical prostatectomy: a systematic review.

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 non-standardized 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 initial studies.

V22 - Single-port radical prostatectomy with using SPORT Surgical System

V22 - Single-port radical prostatectomy with using SPORT Surgical System

Single port radical prostatectomy: current status

The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.

V34 Robotic single port radical prostatectomy: First clinical investigation using a novel robotic system

V34 Robotic single port radical prostatectomy: First clinical investigation using a novel robotic system

PE81: Robotic single port radical prostatectomy: First clinical investigation using a novel robotic system

PE81: Robotic single port radical prostatectomy: First clinical investigation using a novel robotic system