Introduction: Due to pneumoperitoneum and Trendelenburg positioning, epidural-only anesthesia has a limited role in modern robotic or laparoscopic prostate surgery. Transvesical access in single-port (SP) robotic simple and radical prostatectomy allows for flat patient positioning and avoids the peritoneal cavity by limiting the surgical working space and insufflation to the bladder lumen. We sought to determine if epidural anesthesia without the need for paralysis or mechanical ventilation were feasible in patients undergoing transvesical SP simple and radical prostatectomy. Methods: Patients previously scheduled for transvesical SP robotic radical or simple prostatectomy were selected and offered epidural or traditional general anesthesia. Exclusions included underlying obstructive sleep apnea, severe pulmonary disease, prior lumbar spinal surgery, or BMI >35. Low thoracic or high lumbar epidural catheters were placed in the preoperative unit prior to transport to the operating room. The transvesical access technique and basic operative steps of SP transvesical radical and simple prostatectomy are demonstrated. Results: A total of 11 patients underwent epidural placement prior to transvesical SP radical (N=6) and simple (N=5) prostatectomy. All cases were completed by a single surgeon without extra ports, open conversion, or conversion to general anesthesia. No surgical interruptions were noted in 8 of 11 cases and all movement-related interruptions were brief and transient. No anesthetic complications were noted. Intraoperative narcotics were completely avoided in 3 patients. No patients required narcotic medications after discharge and there were no unplanned admissions. Conclusions: Epidural anesthesia without requiring mechanical ventilation is safe and feasible in selected patients undergoing transvesical SP robotic radical and simple prostatectomy. SOURCE OF Funding: none
