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Super-veil nerve-sparing extraperitoneal pure single-port robotic-assisted radical prostatectomy on da Vinci Si robotic system

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Abstract

Objectives

To investigate the safety profile and short-term outcome of super-veil nerve-sparing extraperitoneal single-port robotic-assisted radical prostatectomy (espRARP) on da Vinci Si platform.

Methods

From December 2018 to March 2021, 106 consecutive patients with treatment-naive prostate cancer were prospectively included. espRARP was performed on da Vinci Si surgical platform. Operative time, estimated blood loss, Clavien–Dindo complication classification, continence, potency recovery, quality-of-life scores, and postoperative prostate-specific antigen (PSA) were documented.

Results

Patients aged 52–79 years (mean ± SD, 64.8 ± 6.15 yrs), with a median PSA of 9.2 ng/ml (IQR: 6.70, 16.83) and median prostate volume of 31.9 ml (IQR: 30.01, 38.54). 95.28% (101/106) were clinically localized. All patients underwent espRARP successfully with no open conversions. Operative time was 94.2 ± 30.26 min with an estimated blood loss of 68.5 ml (range, 50–120 ml). No Grade III complications or above were documented. Positive surgical margin was 17.9% (19/106). Median pain score at discharge was 0 (IQR: 0, 1.75) without use of opioid narcotics. Postoperative length of stay was 3 days (IQR: 1, 3), in which 28 patients were discharged within 24 h. Instant, 1-, 3-, and 6 month continence recovery was 18.9, 45.3, 79.2, 93.4, and 96.4%, respectively. Of the 43 patients who received nerve-sparing procedures, 13 (30.23%) resumed potency 6 months postoperatively. 12 month biochemical recurrence-free survival was 92.77% (77/83).

Conclusions

Extraperitoneal single-port robotic-assisted radical prostatectomy is a safe and feasible technique. Combined with super-veil nerve-sparing procedures, it may provide satisfactory outcome in short-term functional recovery.

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References

  1. Smith JA Jr, Herrell SD (2005) Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages? J Clin Oncol: Off J Am Soc Clin Oncol 23:8170–8175

    Article  Google Scholar 

  2. Basiri A, de la Rosette JJ, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H (2018) Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol 36:609–621

    Article  Google Scholar 

  3. Rassweiler JJ, Autorino R, Klein J et al (2017) Future of robotic surgery in urology. BJU Int 120:822–841

    Article  Google Scholar 

  4. Patel VR, Sivaraman A, Coelho RF et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59:702–707

    Article  Google Scholar 

  5. Umari P, Eden C, Cahill D, Rizzo M, Eden D, Sooriakumaran P (2021) Retzius-sparing versus standard robot-assisted radical prostatectomy: a comparative prospective study of nearly 500 patients. J Urol 205:780–790

    Article  Google Scholar 

  6. Good DW, Stewart GD, Stolzenburg JU, McNeill SA (2014) Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. World J Urol 32:1225–1233

    Article  CAS  Google Scholar 

  7. Asimakopoulos AD, Miano R, Di Lorenzo N, Spera E, Vespasiani G, Mugnier C (2013) Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon. Surg Endosc 27:4297–4304

    Article  Google Scholar 

  8. Martini A, Falagario UG, Villers A et al (2020) Contemporary techniques of prostate dissection for robot-assisted prostatectomy. Eur Urol 78:583–591

    Article  Google Scholar 

  9. Ghani KR, Trinh QD, Menon M (2012) Vattikuti institute prostatectomy-technique in 2012. J Endourol 26:1558–1565

    Article  Google Scholar 

  10. Semerjian A, Pavlovich CP (2017) Extraperitoneal robot-assisted radical prostatectomy: indications. Tech Outcomes Curr Urol Rep 18:42

    Article  Google Scholar 

  11. Desai MM, Aron M, Berger A et al (2008) Transvesical robotic radical prostatectomy. BJU Int 102:1666–1669

    Article  Google Scholar 

  12. Kaouk JH, Akca O, Zargar H et al (2016) Descriptive technique and initial results for robotic radical perineal prostatectomy. Urology 94:129–138

    Article  Google Scholar 

  13. Covas Moschovas M, Bhat S, Rogers T et al (2021) Applications of the da Vinci single port (SP) robotic platform in urology: a systematic literature review. Minerva Urol Nephrol 73:6–16

    Article  Google Scholar 

  14. Wilson CA, Aminsharifi A, Sawczyn G et al (2020) Outpatient extraperitoneal single-port robotic radical prostatectomy. Urology 144:142–146

    Article  Google Scholar 

  15. Abaza R, Martinez O, Murphy C, Urkmez A, Davis J (2020) Adoption of single-port robotic prostatectomy: two alternative strategies. J Endourol 34:1230–1234

    Article  Google Scholar 

  16. Chang YF, Gu D, Mei N et al (2020) Initial experience on extraperitoneal single-port robotic-assisted radical prostatectomy. Chin Med J 134:231–233

    Article  Google Scholar 

  17. Hernandez DJ, Nielsen ME, Han M, Partin AW (2007) Contemporary evaluation of the D’amico risk classification of prostate cancer. Urology 70:931–935

    Article  Google Scholar 

  18. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  19. Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369

    Article  Google Scholar 

  20. Huang MM, Patel HD, Wainger JJ et al (2021) Comparison of perioperative and pathologic outcomes between single-port and standard robot-assisted radical prostatectomy: an analysis of a high-volume center and the pooled world experience. Urology 147:223–229

    Article  Google Scholar 

  21. Bertolo R, Garisto J, Bove P, Mottrie A, Rocco B (2021) Perioperative outcomes between single-port and “multi-port” robotic assisted radical prostatectomy: where do we stand? Urology 155:138–143

    Article  Google Scholar 

  22. Chang Y, Lu X, Zhu Q, Xu C, Sun Y, Ren S (2019) Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): initial experience. Asian J Urol 6:294–297

    Article  Google Scholar 

  23. Kaouk J, Valero R, Sawczyn G, Garisto J (2020) Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique. BJU Int 125:182–189

    Article  Google Scholar 

  24. Uy M, Cassim R, Kim J, Hoogenes J, Shayegan B, Matsumoto ED (2021) Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis. J Robot Surg. https://doi.org/10.1007/s11701-021-01245-0

    Article  PubMed  Google Scholar 

  25. Kim KH, Song W, Yoon H, Lee DH (2020) Single-port robot-assisted radical prostatectomy with the da Vinci SP system: a single surgeon’s experience. Investigative and clinical urology 61:173–179

    Article  Google Scholar 

  26. Cochetti G, Boni A, Barillaro F, Pohja S, Cirocchi R, Mearini E (2017) Full neurovascular sparing extraperitoneal robotic radical prostatectomy: our experience with PERUSIA technique. J Endourol 31:32–37

    Article  Google Scholar 

  27. Nielsen ME, Schaeffer EM, Marschke P, Walsh PC (2008) High anterior release of the levator fascia improves sexual function following open radical retropubic prostatectomy. J Urol 180:2557–2564 (discussion 64)

    Article  Google Scholar 

  28. Clarebrough EE, Challacombe BJ, Briggs C et al (2011) Cadaveric analysis of periprostatic nerve distribution: an anatomical basis for high anterior release during radical prostatectomy? J Urol 185:1519–1525

    Article  Google Scholar 

  29. Stolzenburg JU, Holze S, Neuhaus P et al (2021) Robotic-assisted versus laparoscopic surgery: outcomes from the first multicentre, randomised, patient-blinded controlled trial in radical prostatectomy (LAP-01). Eur Urol 79:750–759

    Article  Google Scholar 

  30. Jia Z, Chang Y, Wang Y et al (2021) Sustainable functional urethral reconstruction: maximizing early continence recovery in robotic-assisted radical prostatectomy. Asian J Urol 8:126–133

    Article  Google Scholar 

  31. Morozov A, Barret E, Veneziano D et al (2021) A systematic review of nerve-sparing surgery for high-risk prostate cancer. Minerva Urol Nephrol 73:283–291

    Article  Google Scholar 

  32. Li X, Zhang H, Jia Z et al (2020) Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy. BMC Urol 20:29

    Article  Google Scholar 

  33. Nathan A, Shukla S, Sinha A et al (2022) Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP). J Robot Surg 16:37–43

    Article  Google Scholar 

  34. Hyndman ME, Bivalacqua TJ, Mettee LZ, Su LM, Trock BJ, Pavlovich CP (2015) Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens. Can Urolo Assoc J = Journal de l’Association des urologues du Canada 9:414–419

    Article  Google Scholar 

  35. Lo IS, Lee HY, Chou YH et al (2018) Robot-assisted extraperitoneal radical prostatectomy, single site plus two model. J Laparoendosc Adv Surg Tech A 28:140–144

    Article  Google Scholar 

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Funding

This study is supported by the 2021 Changhai Hospital Educational Sponsorship Fund (CHPY2021B24, General Program, YC), and the 2021 Naval Medical University Basic Science Research Youth Start-up Fund (2021QN29, YC).

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Authors and Affiliations

  1. Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China

    Yifan Chang, Yutian Xiao, Ye Wang, Shi Yan & Shancheng Ren

  2. Department of Urology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China

    Weidong Xu & Shancheng Ren

Authors
  1. Yifan Chang
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  2. Weidong Xu
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  3. Yutian Xiao
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  4. Ye Wang
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  5. Shi Yan
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  6. Shancheng Ren
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Contributions

Design of the manuscript: YC, YX, and SR; acquisition, analysis, and interpretation of the data: WX, YW, S, and YX; drafting of the manuscript: all authors; critical revision of the manuscript: YC, YW, and SR; final approval of the manuscript: all authors; all authors have contributed equally to the manuscript and read and approved the final version of the manuscript.

Corresponding author

Correspondence to Shancheng Ren.

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The authors certify that there are no competing interests to declare.

Ethical approval

This study was conducted following the guidelines of the Institutional Review Board of Changhai Hospital, Naval Medical University, Shanghai, China (#2018–042-02). Informed consent was obtained from all patients, who were fully aware of all available treatment options on admittance. All possible perioperative risks including open conversion were well informed to patients and family before the surgery.

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Chang, Y., Xu, W., Xiao, Y. et al. Super-veil nerve-sparing extraperitoneal pure single-port robotic-assisted radical prostatectomy on da Vinci Si robotic system. World J Urol 40, 1413–1418 (2022). https://doi.org/10.1007/s00345-022-03976-7

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  • DOI: https://doi.org/10.1007/s00345-022-03976-7

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