Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience

Balasubramanian, Shiva; Shiang, Alexander; Vetter, Joel; Henning, Grant; Figenshau, R. Sherburne; Kim, Eric

doi:10.1089/end.2022.0330

Cited by 11 publications

(26 citation statements)

References 20 publications

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“…Our group previously described an association between RS approach and symptomatic lymphocele development [ 13 , 14 ]. Of 3 total 90-day readmissions in the SDD cohort, 2 were caused by lymphoceles following a RS SP-RALP; correlation of RS approach with SDD is likely responsible for the higher, although not significantly different, readmission rate observed in the SDD cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Of 3 total 90-day readmissions in the SDD cohort, 2 were caused by lymphoceles following a RS SP-RALP; correlation of RS approach with SDD is likely responsible for the higher, although not significantly different, readmission rate observed in the SDD cohort. We revised our approach to LND during RS SP-RALP to include peritoneal tacking to allow LND beds to remain open to the peritoneal space [ 13 , 14 ]. However, this study preceded our implementation of peritoneal tacking.…”

Section: Discussionmentioning

confidence: 99%

“…All surgeries utilized the Hasson technique to place the periumbilical SP trocar. Our institution's approach to TP and RS SP-RALP have been previously described [12][13][14]. EP SP-RALP is performed with the same general steps as the TP approach, except the seminal vesicles and vas deferens were dissected anteriorly.…”

Section: Surgical Techniquementioning

confidence: 99%

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Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

et al. 2022

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Purpose The standard discharge pathway following robotic-assisted laparoscopic prostatectomy (RALP) involves overnight hospital admission. Models for same-day discharge (SDD) have been explored for multiport RALP, however, less is known regarding SDD for single-port RALP, especially in terms of patient experience. Methods Patient enrollment, based on preoperative determination of potential SDD eligibility, commenced March 2020 and ended March 2021. Day-of-surgery criteria were utilized to determine which enrolled patients underwent SDD. Differences in preoperative characteristics and perioperative outcomes between patients undergoing SDD and patients undergoing standard discharge were evaluated. A prospectively administered questionnaire was designed to characterize patient-centered factors informing SDD perception. Results Fifteen patients underwent SDD and 36 underwent standard discharge. Overall mean ± SD age and BMI were 63.6 ± 7.0 years and 29.7 ± 4.4 kg/m 2 , respectively. Mean operative time was shorter in the SDD cohort than the standard discharge cohort (188 min vs 217 min, p = 0.011). A higher proportion of cases that underwent SDD were performed using the Retzius-sparing approach, 80% (12/15) vs 33% (12/36) in the standard discharge cohort ( p = 0.005). Rates of 90 day complication ( p = 0.343), 90 day readmission ( p = 0.144), and 90 day emergency department visits ( p = 0.343) rates were all not significantly different between cohorts. Of questionnaire respondents undergoing standard discharge, 32% (8/25) cited pain as a reason for not undergoing SDD. Conclusions With comparable outcomes to the standard discharge pathway, SDD is safe and effective in single-port RALP. Post-operative pain and perceptions of distance are implicated as patient-centered barriers to SDD; proactive pain management and patient education strategies may facilitate SDD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

et al. 2022

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“…SP Retzius-sparing radical prostatectomy (SP-rsRALP) has been described in the past three years by initial experience with the cadaveric model and afterward with few series of patients [ 31 , 32 , 33 , 34 ]. The largest cohort of SP-rsRALP was presented by Balasubramanian S. et al who compared this approach to extraperitoneal and transperitoneal ones.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…The three SP-RALP approaches appear to be safe and feasible, with similarity in terms of perioperative outcomes, oncologic outcomes, and postoperative pain control. Faster and improved returns of both continence and erection were associated with this technique [ 31 ]. However, this surgical procedure presents a steep learning curve and potential complications when compared to other accesses [ 33 ].…”

Section: Evidence Synthesismentioning

confidence: 99%

Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand?

et al. 2023

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In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.

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Single-port robot-assisted radical prostatectomy

Soputro,

Kaouk

2024

World J Urol

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Purpose To provide a comprehensive update on the different techniques and outcomes of contemporary Single-Port (SP) Robotic Radical Prostatectomy (RARP) approaches. Methods A literature review was performed to identify cohort studies that have utilized the purpose-built SP robotic platform (Intuitive Surgical Inc., Sunnyvale, California) for RARP. All published approaches of SP-RARP were included in our review. Baseline clinical, perioperative, and postoperative oncological and functional outcomes were collected from the included studies. Results A total of 16 studies involving 1159 patients were identified. To date, five approaches of SP-RARP have been described, namely Transperitoneal, Extraperitoneal, Retzius-Sparing, Transperineal, and Transvesical. The surgical steps and clinical outcomes of the aforementioned approaches were discussed. While operating times were still faster in the Transperitoneal and Extraperitoneal cohorts, the novel and more regionalized Transvesical approach allowed for radical prostatectomy to be pursued in more patients with previous abdominal surgeries and contributed to significantly improved postoperative outcomes, including the earlier return of urinary continence and with most patients being discharged on the same day without any opioids. Conclusion Based on the existing literature, the introduction of SP-RARP not only enriched the repertoire of minimally-invasive surgical treatment options for prostate cancer but also provided the opportunity for urologists to develop new techniques that can improve perioperative outcomes and postoperative quality of life. Given the limited number of patients and heterogeneity in the patient selection and reporting of postoperative outcomes, further research remains necessary to better understand the different benefits and improve patient selection algorithms for the different techniques.

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Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience

Cited by 11 publications

References 20 publications

Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand?

Single-port robot-assisted radical prostatectomy

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