Jeffrey C Bassett1, Salpi Salibian1, Simone Crivellaro2. 1. Department of Hoag Urologic Oncology, Hoag Memorial Presbyterian Hospital, Newport Beach, California, USA. 2. Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
Abstract
Background: To determine safety and feasibility of single-port Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA) robotic platform in men with adenocarcinoma of the prostate. Patients and Methods: Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for perioperative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. Results: Mean (standard deviation) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative prostate-specific antigen (PSA) was 10.2 ng/mL. Average prostate weight was 42 g. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in 24 (86%) patients and nerve sparing in 14 (46%) patients. Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for postoperative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration and dilation of bladder neck contracture). Pathologic grade group was group 1 (0%), group 2 (57%), group 3 (29%), and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA during follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Postoperative mean sexual health inventory for men score in those who underwent nerve sparing was 18 at 3 months follow-up. Conclusions: SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes requires longer follow-up and larger cohort validation.
Background: To determine safety and feasibility of single-port Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA) robotic platform in men with adenocarcinoma of the prostate. Patients and Methods: Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for perioperative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. Results: Mean (standard deviation) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative prostate-specific antigen (PSA) was 10.2 ng/mL. Average prostate weight was 42 g. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in 24 (86%) patients and nerve sparing in 14 (46%) patients. Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for postoperative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration and dilation of bladder neck contracture). Pathologic grade group was group 1 (0%), group 2 (57%), group 3 (29%), and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA during follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Postoperative mean sexual health inventory for men score in those who underwent nerve sparing was 18 at 3 months follow-up. Conclusions: SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes requires longer follow-up and larger cohort validation.