Introduction: Currently there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to measure single-institution (two surgeons) SP RALP outcomes and then compare them to XI RALP outcomes. Finally, we sought to examine whether SP operative outcomes improved as a function of time as the surgeon became increasingly familiar with the platform.
Methods: Patients who underwent prostatectomy at our institution between August 2019 to April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one of two urologists at our institution. 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. All analysis was carried out using Stata version 16 (StataCorp LLC 2019).
Results: Complete records were available for 182 patients. Of the total patient population 82 (45.1%) underwent SP prostatectomy compared to 100 (55.0%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65.6 vs. 64.3 years; p=0.20), BMI (28.5 vs 29.3; p=0.25), preop ASA score >=3 (67.1% vs. 69.0%; p=0.78), or preop PSA (8.72 vs. 10.22, p=0.18). There was a significantly lower procedure time for SP prostatectomy (183.5 vs. 253.5 min, p. <0.001). Estimated blood loss between the two modalities were statistically similar (121 vs. 158 mL; p=0.056). There was no difference in average length of stay (1.13 vs. 1.18 days; p=0.77). There were no differences in distribution of total Gleason score (p=0.26) or Gleason grade group (p=0.28) between the two groups. SP prostatectomy had significantly lower rate of positive surgical margins (24.3% vs. 54.0%; p=0.001). Both groups had six patients with a documented and graded Clavien-Dindo complication, though there was no difference in the distribution in severity by group (p=0.48). There was a significantly lower number of lymph nodes removed in patients undergoing SP prostatectomy (4.1 vs 4.9; p=0.043).
Conclusions: To date, this reports on the largest cohort of patients who underwent SP RALP. Importantly, it is one of the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to be emerging benefits to SP prostatectomy vs. XI with regards to procedure time and positive margins, though we noted a significantly higher number of nodes removed with XI prostatectomy compared to SP. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising, and possibly improving outcomes.
.jpg)
.jpg)