Extraperitoneal versus Transperitoneal Single Port Robotic Radical Prostatectomy: A Comparative Analysis of Perioperative Outcomes

Kaouk, Jihad; Aminsharifi, Alireza; Wilson, Clark A.; Sawczyn, Guilherme; Garisto, Juan; Francavilla, Simone; Abern, Michael R.; Crivellaro, Simone

doi:10.1097/ju.0000000000000700

Cited by 75 publications

(28 citation statements)

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“…Moreover, although we are reporting the first cases on the learning curve with this new technology, our technique presented acceptable operative times and rate of PSM, we attribute this to maintaining our conventional technique and to the help of the assistant port. Our functional outcomes are also compatible or improved compared with the published literature available on da Vinci SP clinical use [19,20]. Our present outcomes for SP RARP are similar to outcomes we have published in the past for multiport RARP.…”

Section: Discussionsupporting

confidence: 85%

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Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

et al. 2020

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To describe the crucial factors related to the implementation of the da Vinci single-port (SP) system (Intuitive Surgical Inc., Sunnyvale, CA, USA), and the early outcomes after the introduction of this robot for robot-assisted radical prostatectomy (RARP). Patients and methods We prospectively collected data from 50 consecutive patients with prostate adenocarcinoma who underwent RARP using this robot. The median follow-up was 53 days. We performed a transperitoneal technique. The robotic (multiport) trocar was placed on the supra-umbilical midline 20 cm from the pubis and an assistant trocar placed in the right lower quadrant. We report our initial experience describing the intra-and postoperative outcomes associated with this new robot. Also, we report the early functional and oncological outcomes in the follow-up period considered. Continuous variables were described as medians and interquartile ranges, while categorical variables as frequencies and proportions. Results The median total operative time was 118 min, median console time was 80 min, and median estimated blood loss was 50 mL. There were no intraoperative complications or blood transfusions. The final pathology reported 18% Grade Group (GrGp)1, 58% GrGp2, 18% GrGp3, 2% GrGp4, and 4% GrGp5. In all, 40 patients (80%) were pT2 and 20% were ≥pT3a. The overall positive surgical margin rate was 14%. In all, 39 patients (78%) achieved full continence at median of 21 days after RARP. The median pain scale (0-10) score at 8, 12 and 16 h after RARP was 2, 2, and 0, respectively. Conclusion The use of the da Vinci SP robot with an additional assistant port for RARP is technically safe and feasible, with acceptable short-term functional and oncological outcomes. However, there is a technical learning curve for this new platform due to the smaller scope of the operative field and the decreased flexibility and strength of the surgical instruments.

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Section: Discussionsupporting

confidence: 85%

“…Kaouk et al [20] have recently published a comparison study of a trans-vs extraperitoneal approach to RP with the SP console. In this multicentric study, the author compared two groups (52 extra-and 46 transperitoneal), and reported the peri-and postoperative parameters related to both approaches.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

et al. 2020

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“… 30 As the lateral ports are eliminated, the risk of an inadvertent peritoneal puncture is significantly decreased. 19 In our study, there was no peritoneal damage in the SP group, even in patients with a history of lower abdominal surgery, while there was a significant increase in peritoneal damage in the MP group, especially in patients with a history of abdominal surgery. In the current study, the total complication rate of the SP group was not significantly different from that of the MP group, and there were no complications worse than Clavien–Dindo III grade.…”

Section: Discussioncontrasting

confidence: 42%

“… 17 18 The extraperitoneal approach avoids the peritoneal cavity, has little effect on intestinal function, and does not require Trendelenburg position; thus, it shortens postoperative convalescence. 19 Therefore, whether extraperitoneal robotic single-port radical prostatectomy (epR-spRP) will benefit to patients is unclear.…”

Section: Introductionmentioning

confidence: 99%

A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System

Wang

Shi

et al. 2021

Asian Journal of Andrology

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To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients ( P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group ( P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group ( P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group ( P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively ( P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients.

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“…This was similarly seen in studies comparing extra- and trans-peritoneal MP robotic prostatectomy. PSA levels and continence outcomes at 90 days showed no statistical difference between the extra- and intra-peritoneal prostatectomy groups [ 5 ].…”

mentioning

confidence: 99%

A comparative analysis of single port versus multi-port robotic assisted radical prostatectomy for prostate cancer

Walsh

2020

Investig Clin Urol

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Extraperitoneal versus Transperitoneal Single Port Robotic Radical Prostatectomy: A Comparative Analysis of Perioperative Outcomes

Cited by 75 publications

References 0 publications

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System

A comparative analysis of single port versus multi-port robotic assisted radical prostatectomy for prostate cancer

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