Investig Clin Urol.  2020 Mar;61(2):173-179. 10.4111/icu.2020.61.2.173.

Single-port robot-assisted radical prostatectomy with the da Vinci SP system: A single surgeon's experience

Affiliations
  • 1Department of Urology, Ewha Womans University Seoul Hospital, Seoul, Korea. khkim.uro@gmail.com
  • 2Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea.

Abstract

PURPOSE
To report an initial single-surgeon experience with single-port robot-assisted radical prostatectomy (SP-RARP) using the da Vinci SP surgical system (Intuitive Surgical, USA).
MATERIALS AND METHODS
Between December 2018 and October 2019, a single surgeon performed SP-RARP in 20 patients with prostate cancer. SP-RARP was performed using the conventional approach through an umbilical port with a GelPOINT access system (Applied Medical, USA) and an additional assist port. During surgery, the camera was placed in the 6- or 12-o'clock position, and a traction arm was placed in the counterpart position for upward or downward traction. Clinicopathologic data, perioperative data, and short-term surgical outcomes were analyzed.
RESULTS
Of 20 patients, 45% of patients had pT3 or greater disease and 45% had Gleason grade 4 to 5, respectively. In 11 patients that underwent lymph node dissection, the median number of lymph nodes removed was 19 (interquartile range [IQR], 14-22). Median operative time was 245 minutes (IQR, 200-255), and median console time was 190 minutes (IQR, 165-210). Median blood loss was 200 mL (IQR, 150-300 mL), and there were no intraoperative complications or open conversion. In 10 patients with a follow-up period longer than 3 months, one patient experienced biochemical recurrence, and all patients required 0 to 1 pads per day. Of seven patients that were potent before surgery, four recovered erectile function sufficient for intercourse.
CONCLUSIONS
Our report shows the safety and feasibility of SP-RARP, and that the associated surgical outcomes with short-term follow-up are satisfactory.

Keyword

Prostatectomy; Prostatic neoplasms; Robotics

MeSH Terms

Arm
Follow-Up Studies
Humans
Intraoperative Complications
Lymph Node Excision
Lymph Nodes
Operative Time
Prostatectomy*
Prostatic Neoplasms
Recurrence
Robotics
Traction

Figure

  • Fig. 1 (A) Umbilical incision for port placement, (B) final incision after surgery, (C) and (D) port placement for single-port robot-assisted radical prostatectomy (SP-RARP). The assist port should be place at least 7 cm from the SP port, and the working space should be within 10 to 25 cm from the SP port for robotic arm triangulation.

  • Fig. 2 The single-port robot-assisted radical prostatectomy (SP-RARP) surgical procedures. The camera was placed in the 6-o'clock position during (A) seminal vesicle dissection, (D) posterior bladder neck dissection, and (E) neurovascular bundle dissection with upward traction created by Cadiere forceps in the 12-o'clock position. (B) Umbilical ligament transection, (C) bladder neck transection, (F) apex dissection, and (G) urethrovesical anastomosis were performed with the camera positioned at 12 o'clock.

  • Fig. 3 (A) Console time and (B) estimated blood loss for single-port robot-assisted radical prostatectomy. PLND, pelvic lymph node dissection; EBL, estimated blood loss.


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