OBJECTIVES: To evaluate the feasibility of robot-assisted single-port (SP) transvesical partial prostatectomy (TVPP) using a novel purpose-built SP surgical platform in a pre-clinical model. METHODS: The cadavers were placed in the lithotomy position. A 3-cm midline incision was made in the suprapubic area 4-cm from the symphisis pubis. After opening the Retzius space, an access mini device (GelPOINT; Applied Medical, Rancho Margarita, CA, USA) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was docked to the GelPOINT by inserting a novel SP cannula through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: (i) antegrade dissection of the transition zone at the bladder neck; (ii) lateral excision of the peripheral zone; and (iii) urethrovesical anastomosis. Primary outcomes, such as intra-operative complications, rate of conversion to standard techniques and operating times, were recorded. RESULTS: The SP-TVPP procedure was technically completed in three male cadavers. All cases were completed successfully using the da Vinci SP1098 surgical system without conversion or the need for additional ports. There were no intra-operative complications. The mean total operating time was 49.3 min. CONCLUSION: Robot-assisted TVPP is feasible using a novel purpose-built SP surgical platform in a cadaver model. Future clinical evaluation in humans is needed for assessment on patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques is warranted.
OBJECTIVES: To evaluate the feasibility of robot-assisted single-port (SP) transvesical partial prostatectomy (TVPP) using a novel purpose-built SP surgical platform in a pre-clinical model. METHODS: The cadavers were placed in the lithotomy position. A 3-cm midline incision was made in the suprapubic area 4-cm from the symphisis pubis. After opening the Retzius space, an access mini device (GelPOINT; Applied Medical, Rancho Margarita, CA, USA) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was docked to the GelPOINT by inserting a novel SP cannula through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: (i) antegrade dissection of the transition zone at the bladder neck; (ii) lateral excision of the peripheral zone; and (iii) urethrovesical anastomosis. Primary outcomes, such as intra-operative complications, rate of conversion to standard techniques and operating times, were recorded. RESULTS: The SP-TVPP procedure was technically completed in three male cadavers. All cases were completed successfully using the da Vinci SP1098 surgical system without conversion or the need for additional ports. There were no intra-operative complications. The mean total operating time was 49.3 min. CONCLUSION: Robot-assisted TVPP is feasible using a novel purpose-built SP surgical platform in a cadaver model. Future clinical evaluation in humans is needed for assessment on patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques is warranted.
Authors: Ryan W Dobbs; Whitney R Halgrimson; Susan Talamini; Hari T Vigneswaran; Jessica O Wilson; Simone Crivellaro Journal: World J Urol Date: 2019-08-28 Impact factor: 4.226