Fellow Cleveland Clinic, Glickman Urological & Kidney Institute
Introduction: To describe our surgical technique for single port (SP) transvesical robotic radical prostatectomy using the da Vinci SPâ surgical system (Intuitive Surgical, Sunnyvale, CA, USA).
Methods: Sixty-eight patients underwent SP radical prostatectomy through a transvesical approach. Patient selection criteria was localized intermediate risk prostate cancer. Through a 3 cm suprapubic midline incision the bladder was entered and the Da Vinci Single-Port Access Kit was used for access. Floating docking technique was used. Through the access kit, the dedicated multichannel port, an 8 mm assistant port, and the remotely operated suction irrigation system were introduced. The surgical steps for transvesical radical prostatectomy were performed in the following order. 1) Posterior bladder neck dissection, 2) Vas deferens and seminal vesicle dissection, 3) Posterior dissection, 4) Anterior bladder neck and prostate dissection, 5) Pedicle and neurovascular bundle dissection, 6) Posterior Reconstruction and Urethrovesical Anostomosis, 7) removal of prostate through a single incision and bladder closure.
Results: Mean patients’ age was 62.2 years and the mean preoperative prostate-specific antigen (PSA) was 6.4 ng/mL. Single port robotic transvesical radical prostatectomy was performed successfully in 68 patients successfully without the need for additional port placement or open conversions. Average operative time was 210 minutes. Mean estimated blood loss was 116 mL. Eight patients had positive surgical margins (11.8%). Median length of stay was 4 hours (outpatient setting). Median time with a Foley catheter after surgery was 4.1 days. 46 patients (75.4%) had immediate continence (0-1 pad) after foley removal. Continence rate was 96.7% at postoperative 3 months. No perioperative or postoperative complications were recorded.
Conclusions: SP transvesical robotic radical prostatectomy is a novel approach that provides advantages including single incision, no additional ports, minimal opioid use, immediate continence, and same day discharge without compromising intraoperative and oncological outcomes.