Abstract
Currently, there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to compare our single-institution single-surgeon SP RALP experience to our XI RALP experience with regard to patient selection, perioperative data, and outcomes. Patients who underwent prostatectomy at our institution between August 2019 and April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one urologist at our institution to limit inter-surgeon variability. Demographic and clinical information were extracted from the medical record in standardized fashion. All documented classifications were graded using the Clavien–Dindo classification system. Patients with previous prostate cancer therapies were excluded. Categorical variables were compared using Chi-square or Fisher’s exact test where appropriate. Continuous variables were compared using t tests or Wilcoxon rank sum tests where appropriate. Complete records were available for 208 patients. Of the total patient population 127 (61.1%) underwent SP prostatectomy compared to 81 (38.9%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65 vs. 66 years; p = 0.60), BMI (29.2 vs. 30.1; p = 0.22), preop ASA score ≥ 3 (68.5% vs. 64.2%; p = 0.52), or preop PSA (7.1 vs. 7.4, p = 0.94). There no difference in procedure time for SP prostatectomy (170 vs. 168 min, p = 0.035), estimated blood loss (100 vs. 100 mL; p = 0.14), or average length of stay (1 vs. 1 days; p = 0.22). There was a significant difference in Gleason grade group between the two cohorts with patients undergoing XI RALRP more likely to have higher stage disease (p = 0.025) and a trend towards higher D’Amico risk scores in the XI group (p = 0.053). There was no difference in rate of positive surgical margins (29.9% vs. 29.6%; p = 0.96). There was no difference in the distribution of complications between the two groups (p = 0.99) with 89% of patients having no complication. There was no difference in the number of lymph nodes removed by modality (p = 0.94). To date, this study represents one of the largest cohorts of patients who underwent SP RALP. Importantly, it is among the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to minimal differences in patient factors, perioperative results, or outcomes between the platforms. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising outcomes.
Similar content being viewed by others
Availability of data and materials
Not publicly available.
References
Van Koughnett JA, Jayaraman S, Eagleson R, Quan D, Van Wynsberghe A, Schlachta CM (2009) Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon’s perspective? J Robot Surg 3(2):1
Estes SJ, Goldenberg D, Winder JS, Juza RM, Lyn-Sue JR (2017) Best practices for robotic surgery programs. J Soc Laparoendosc Surg 21(2):1
Dobbs RW, Halgrimson WR, Talamini S, Vigneswaran HT, Wilson JO, Crivellaro S (2020) Single-port robotic surgery: the next generation of minimally invasive surgery. World J Urol 38(4):897–905
Ng C-F, Teoh JY-C, Chiu PK-F, Yee C-H, Chan C-K, Hou SS-M, Kaouk J, Chan ES-Y (2019) Robot-assisted single-port radical prostatectomy: a phase 1 clinical study. Int J Urol 26:878–883
Dindo D, Demartines N, Clavien PA (2004) Classifications of surgical complications. Ann Surg 240(2):205–213
Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J (2021) Single-institution cost comparison: single-port versus multiport robotic prostatectomy. Eur Urol Focus 7(3):1
Vigneswaran HT, Schwarzman LS, Francavilla S, Abern MR, Crivellaro S (2020) A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy. Eur Urol 77(6):1
Dobbs RW, Halgrimson WR, Madueke I, Vigneswaran HT, Wilson JO, Crivellaro S (2019) Single-port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci® SP platform. BJU Int 124(6):1
Kaouk J, Bertolo R, Eltemamy M, Garisto J (2019) Single-port robot-assisted radical prostatectomy: first clinical experience using the SP surgical system. Urology 124:309
Ju GQ, Wang ZJ, Shi JZ, Zhang ZQ, Wu ZJ, Yin L et al (2021) A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System. Asian J Androl 23(6):10
Agarwal DK, Sharma V, Toussi A, Viers BR, Tollefson MK, Gettman MT et al (2020) Initial experience with da Vinci single-port robot-assisted radical prostatectomies. Eur Urol 77(3):53
Noël J, Moschovas MC, Sandri M, Bhat S, Rogers T, Reddy S et al (2022) Patient surgical satisfaction after da Vinci® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis. J Robot Surg 16(2):1
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(1):182–189
Badani KK, Reddy BN, Moskowitz EJ, Paulucci DJ, Beksac AT, Martini A, Whalen MJ, Skarecky DW, Huynh LM, Ahlering TE (2018) Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesical invasion and node-negative disease. Urol Oncol 36(6):310.e1-e6
Lenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J (2021) Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int 128(6):1
Funding
None.
Author information
Authors and Affiliations
Contributions
SSR—data analysis, manuscript preparation. AAS—data collection, assistance with manuscript preparation. MJW—data analysis, manuscript preparation. AS—manuscript preparation, primary surgeon.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethical approval
Erlanger Institutional Review Board approved this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Roy, S.S., Sathe, A.A., Watson, M.J. et al. Comparison of robotic-assisted laparoscopic radical prostatectomy: SP versus XI, a single surgeon experience. J Robotic Surg 17, 2817–2821 (2023). https://doi.org/10.1007/s11701-023-01720-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-023-01720-w