First 100 cases of transvesical single-port robotic radical prostatectomy

doi:10.1016/j.ajur.2022.12.005

Asian Journal of Urology, 2023, 10 (4): 416-422 doi: 10.1016/j.ajur.2022.12.005

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First 100 cases of transvesical single-port robotic radical prostatectomy

Roxana Ramos-Carpinteyro,Ethan L. Ferguson,Jaya S. Chavali,Albert Geskin,Jihad Kaouk^*(

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Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

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Abstract

Objective: To describe the surgical technique and report the early outcomes of the transvesical (TV) approach to single-port (SP) robot-assisted radical prostatectomy.

Methods: All procedures were performed at a single center by one surgeon. We identified the first 100 consecutive patients with clinically localized prostate cancer that underwent SP TV robot-assisted radical prostatectomy using the da Vinci SP robotic surgical system. Data were collected prospectively and analyzed with descriptive statistics. The primary outcomes assessed were postoperative urinary continence, rate of biochemical recurrence, and sexual function.

Results: All procedures were performed without extra ports or conversion. The median age was 62.1 years and 49.0% of the patients had abdominal surgery history. The preoperative median prostate-specific antigen value and prostate volume were 5.0 ng/mL and 33.0 mL, respectively. There were no intraoperative complications. The median operative time and estimated blood loss were 212.5 min and 100.0 mL, respectively. A total of 92.0% of patients were discharged within 24.0 h, with an overall median length of stay of 5.6 h. Only 4.0% of patients required opioid prescriptions at discharge. The median Foley catheter duration was 3 days. Positive margins were present in 15.0% of cases. Median follow-up was 10.4 months. Continence rate was immediate after Foley removal in 49.0% of cases, 65.0% at 2 weeks, 77.4% at 6 weeks, 94.1% at 6 months, and 98.9% at 1 year. One case of biochemical recurrence (1.0%) was noted 3 months after surgery.

Conclusion: The SP TV approach for radical prostatectomy cases is a safe and feasible technique for patients with clinically localized prostate cancer. This technique offers advantages of short hospital stay, minimal narcotic use postoperatively, and promising early return of urinary continence, without compromising oncologic outcomes.

Key words： Prostate cancer Radical prostatectomy Robotic-assisted surgery Single-port Minimally-invasive surgery

Received: 08 September 2022 Available online: 20 October 2023

Corresponding Authors: *E-mail address: kaoukj@ccf.org (J. Kaouk).

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Cite this article:

Roxana Ramos-Carpinteyro,Ethan L. Ferguson,Jaya S. Chavali, et al. First 100 cases of transvesical single-port robotic radical prostatectomy[J]. Asian Journal of Urology, 2023, 10(4): 416-422.

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http://www.ajurology.com/EN/10.1016/j.ajur.2022.12.005 OR http://www.ajurology.com/EN/Y2023/V10/I4/416

Patient preparation. (A) Dorsal decubitus position, parallel to the ground; (B) Suprapubic midline single incision of 3.5 cm.

Access port and robot docking. (A) Da Vinci SP access port; (B) Docked robot; (C) Robot inside bladder illustration.

Transvesical dissection and vesico-urethral anastomosis. (A) Posterior dissection illustration; (B) Posterior dissection; (C) Vas deferens transection (right); (D) Seminal vesicle artery ligation (left); (E) Anterior dissection; (F) Vascular pedicle ligation (left); (G) Vascular pedicle ligation (left) illustration; (H) Dorsal venous complex ligation; (I) Urethral transection; (J) Pulling prostate into bladder; (K) Lymph node dissection (right); (L) Anastomosis beginning at 6 o’clock; (M) Anastomosis illustration; (N) Complete anastomosis, inflated Foley catheter balloon, specimen resting on bladder.

Postoperative scar.

Demographic and baseline characteristics (n=100).

Perioperative and pathology outcomes (n=100).

Percentage of continent patients after transvesical single-port robot-assisted radical prostatectomy.

Sexual function after transvesical single-port robot-assisted radical prostatectomy. ED, erectile dysfunction; PDE5, phosphodiesterase-5; SHIM, Sexual Health Inventory for Men.

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