Skip to main content

Advertisement

SpringerLink
Log in

Initial experience with extraperitoneal robotic-assisted simple prostatectomy using the da Vinci SP surgical system

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Robotic-assisted simple prostatectomy (RASP) has emerged as a safe and effective treatment option for symptomatic patients with lower urinary tract symptoms related to significant benign prostatic enlargement (BPE) above 80 g. The recent release of the da Vinci SP robotic system (Intuitive, Sunnyvale, CA, USA) continues to advance the minimally invasive nature of robotic surgical technology. We now report our institution’s initial experience performing RASP using the da Vinci SP robotic system. An IRB-approved, retrospective chart review was performed of all patients undergoing robotic-assisted simple prostatectomy using the da Vinci SP surgical system in the treatment of benign prostatic enlargement by a single surgeon from March to June 2019. Pre-operative, intraoperative, and post-operative data were collected for descriptive analysis. A total of 10 men, mean age of 69 ± 4 years, with mean prostate volume of 104 ± 11 g underwent surgery. The robotic cannula and a single assistant port were utilized in all cases. No cases required conversion to a multi-port robotic platform or open approach, nor required the placement of additional assistant ports. No intraoperative or immediate post-operative complications were noted. Mean estimated blood loss was 141 ± 98 mL and operative time was 172 ± 19 min. Mean catheter time was 1.9 ± 1.8 days. One patient reported transient de novo stress urinary incontinence. Single-port RASP is a safe and effective intervention for BPE. The smaller surgical footprint from the device appears to make earlier catheter removal possible. Comparative evaluation with multi-port RASP and other modalities is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Roehrborn CG (2005) Benign prostatic hyperplasia: an overview. Rev Urol 7(Suppl 9):S3

    PubMed  PubMed Central  Google Scholar 

  2. Speakman M, Kirby R, Doyle S, Ioannou C (2015) Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)—focus on the UK. BJU Int 115(4):508–519. https://doi.org/10.1111/bju.12745

    Article  PubMed  Google Scholar 

  3. Yang Q, Peters TJ, Donovan JL, Wilt TJ, Abrams P (2001) Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. J Urol 165(5):1526–1532

    Article  CAS  Google Scholar 

  4. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803. https://doi.org/10.1016/j.juro.2011.01.074

    Article  PubMed  Google Scholar 

  5. Pariser JJ, Famakinwa OJ, Pearce SM, Chung DE (2014) High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness. J Endourol 28(11):1357–1362. https://doi.org/10.1089/end.2014.0336

    Article  PubMed  Google Scholar 

  6. Elzayat EA, Elhilali MM (2007) Holmium laser enucleation of the prostate (HoLEP): long-term results, reoperation rate, and possible impact of the learning curve. Eur Urol 52(5):1465–1471. https://doi.org/10.1016/j.eururo.2007.04.074

    Article  PubMed  Google Scholar 

  7. Brunckhorst O, Ahmed K, Nehikhare O, Marra G, Challacombe B, Popert R (2015) Evaluation of the learning curve for holmium laser enucleation of the prostate using multiple outcome measures. Urology 86(4):824–829. https://doi.org/10.1016/j.urology.2015.07.021

    Article  PubMed  Google Scholar 

  8. Sutherland DE, Perez DS, Weeks DC (2011) Robot-assisted simple prostatectomy for severe benign prostatic hyperplasia. J Endourol 25(4):641–644. https://doi.org/10.1089/end.2010.0528

    Article  PubMed  Google Scholar 

  9. Sorokin I, Sundaram V, Singla N, Walker J, Margulis V, Roehrborn C, Gahan JC (2017) Robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia in large glands: a propensity score-matched comparison of perioperative and short-term outcomes. J Endourol 31(11):1164–1169. https://doi.org/10.1089/end.2017.0489

    Article  PubMed  Google Scholar 

  10. Johnson B, Sorokin I, Singla N, Roehrborn C, Gahan JC (2018) Determining the learning curve for robot-assisted simple prostatectomy in surgeons familiar with robotic surgery. J Endourol 32(9):865–870

    Article  Google Scholar 

  11. Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL, Castillo O, Matei DV, Celia A, Koc G, Vora A, Aron M, Parsons JK, Pini G, Jensen JC, Sutherland D, Cathelineau X, Nunez Bragayrac LA, Varkarakis IM, Amparore D, Ferro M, Gallo G, Volpe A, Vuruskan H, Bandi G, Hwang J, Nething J, Muruve N, Chopra S, Patel ND, Derweesh I, Champ Weeks D, Spier R, Kowalczyk K, Lynch J, Harbin A, Verghese M, Samavedi S, Molina WR, Dias E, Ahallal Y, Laydner H, Cherullo E, De Cobelli O, Thiel DD, Lagerkvist M, Haber GP, Kaouk J, Kim FJ, Lima E, Patel V, White W, Mottrie A, Porpiglia F (2015) Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American multi-institutional analysis. Eur Urol 68(1):86–94. https://doi.org/10.1016/j.eururo.2014.11.044

    Article  PubMed  Google Scholar 

  12. Lucca I, Shariat SF, Hofbauer SL, Klatte T (2015) Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis. World J Urol 33(4):563–570. https://doi.org/10.1007/s00345-014-1324-3

    Article  PubMed  Google Scholar 

  13. Shah AA, Gahan JC, Sorokin I (2018) Comparison of robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia. Curr Urol Rep 19(9):71. https://doi.org/10.1007/s11934-018-0820-1

    Article  PubMed  Google Scholar 

  14. Elsamra SE, Gupta N, Ahmed H, Leavitt D, Kreshover J, Kavoussi L, Richstone L (2014) Robotic assisted laparoscopic simple suprapubic prostatectomy—the Smith Institute for Urology experience with an evolving technique. Asian J Urol 1(1):55–59. https://doi.org/10.1016/j.ajur.2015.04.006

    Article  PubMed  Google Scholar 

  15. Leslie S, Abreu AL, Chopra S, Ramos P, Park D, Berger AK, Desai MM, Gill IS, Aron M (2014) Transvesical robotic simple prostatectomy: initial clinical experience. Eur Urol 66(2):321–329. https://doi.org/10.1016/j.eururo.2013.12.020

    Article  PubMed  Google Scholar 

  16. Pokorny M, Novara G, Geurts N, Dovey Z, De Groote R, Ploumidis A, Schatteman P, de Naeyer G, Mottrie A (2015) Robot-assisted simple prostatectomy for treatment of lower urinary tract symptoms secondary to benign prostatic enlargement: surgical technique and outcomes in a high-volume robotic centre. Eur Urol 68(3):451–457. https://doi.org/10.1016/j.eururo.2015.03.003

    Article  PubMed  Google Scholar 

  17. Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R (2008) Robotic simple prostatectomy. J Urol 179(2):513–515. https://doi.org/10.1016/j.juro.2007.09.065

    Article  PubMed  Google Scholar 

  18. John H, Bucher C, Engel N, Fischer B, Fehr JL (2009) Preperitoneal robotic prostate adenomectomy. Urology 73(4):811–815. https://doi.org/10.1016/j.urology.2008.09.028

    Article  PubMed  Google Scholar 

  19. Stolzenburg JU, Kallidonis P, Kyriazis I, Kotsiris D, Ntasiotis P, Liatsikos EN (2018) Robot-assisted simple prostatectomy by an extraperitoneal approach. J Endourol 32(S1):S39–S43. https://doi.org/10.1089/end.2017.0714

    Article  PubMed  Google Scholar 

  20. Gilling PJ (2017) Editorial comment on: comparison of perioperative outcomes between holmium laser enucleation of the prostate and robot-assisted simple prostatectomy by Zhang et al. (From: Zhang MW, El Tayeb MM, Borofsky MS, et al. J Endourol 2017;31:847-850). J Endourol 31(11):1216. https://doi.org/10.1089/end.2017.0639

    Article  PubMed  Google Scholar 

  21. Kaplan SA (2016) Re: perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American multi-institutional analysis. J Urol 196(4):1218–1221. https://doi.org/10.1016/j.juro.2016.07.031

    Article  PubMed  Google Scholar 

  22. Montorsi F, Gandaglia G (2015) Re: Riccardo Autorino, Homayoun Zagar, Mirandolino B. Mariano, et al. Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American Multi-institutional Analysis. Eur Urol 2015;68:86–94. Re: Matthew Bultitude, Ben Challacombe. Simple prostatectomy: a step too far for laparoscopy? Eur Urol 2015;68:95–6. European urology 68(1):e7–8. https://doi.org/10.1016/j.eururo.2015.01.022

    Article  PubMed  Google Scholar 

  23. Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KA, Gravas S (2015) EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109

    Article  Google Scholar 

  24. Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, Lightner DJ, Parsons JK, Roehrborn CG, Welliver C, Wilt TJ, McVary KT (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. j Urol 200(3):612–619. https://doi.org/10.1016/j.juro.2018.05.048

    Article  PubMed  Google Scholar 

  25. Umari P, Fossati N, Gandaglia G, Pokorny M, De Groote R, Geurts N, Goossens M, Schatterman P, De Naeyer G, Mottrie A (2017) Robotic assisted simple prostatectomy versus holmium laser enucleation of the prostate for lower urinary tract symptoms in patients with large volume prostate: a comparative analysis from a high volume center. J Urol 197(4):1108–1114. https://doi.org/10.1016/j.juro.2016.08.114

    Article  PubMed  Google Scholar 

  26. Zhang MW, El Tayeb MM, Borofsky MS, Dauw CA, Wagner KR, Lowry PS, Bird ET, Hudson TC, Lingeman JE (2017) Comparison of perioperative outcomes between holmium laser enucleation of the prostate and robot-assisted simple prostatectomy. J Endourol 31(9):847–850. https://doi.org/10.1089/end.2017.0095

    Article  PubMed  Google Scholar 

  27. Kampantais S, Dimopoulos P, Tasleem A, Acher P, Gordon K, Young A (2018) Assessing the learning curve of holmium laser enucleation of prostate (HoLEP). A systematic review. Urology 120:9–22. https://doi.org/10.1016/j.urology.2018.06.012

    Article  PubMed  Google Scholar 

  28. Shigemura K, Yamamichi F, Kitagawa K, Yamashita M, Oka Y, Tanaka H, Fujisawa M (2017) Does surgeon experience affect operative time, adverse events and continence outcomes in holmium laser enucleation of the prostate? A review of more than 1,000 cases. J Urol 198(3):663–670. https://doi.org/10.1016/j.juro.2017.04.087

    Article  PubMed  Google Scholar 

  29. Hoag NA, Mamut A, Afshar K, Amling C, Mickelson JJ, Macneily AE (2012) Trends in urology resident exposure to minimally invasive surgery for index procedures: a tale of two countries. J Surg Educ 69(5):670–675. https://doi.org/10.1016/j.jsurg.2012.04.007

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, MC 9110, Dallas, TX, 75390, USA

    Ryan L. Steinberg, Niccolo Passoni, Alaina Garbens, Brett A. Johnson & Jeffrey C. Gahan

Authors
  1. Ryan L. Steinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niccolo Passoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alaina Garbens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brett A. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeffrey C. Gahan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey C. Gahan.

Ethics declarations

Conflict of interest

R. Steinberg, N. Passoni, A. Garbens, B. Johnson, and J. Gahan declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steinberg, R.L., Passoni, N., Garbens, A. et al. Initial experience with extraperitoneal robotic-assisted simple prostatectomy using the da Vinci SP surgical system. J Robotic Surg 14, 601–607 (2020). https://doi.org/10.1007/s11701-019-01029-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-019-01029-7

Keywords

Search

Navigation