Introduction: Cross-sectional imaging guided prostate biopsy has allowed for more accurate diagnosis of clinically localized prostate cancer. Appropriately counseled patients with low or intermediate risk localized disease may opt for focal or ablative therapies. Recently, partial prostatectomy has been shown to be safe and effective for anterior prostate tumors. The single port da Vinci surgical platform with a transvesical approach allows for anterograde dissection of the prostate gland with minimal disturbance to the space of retzius and has recently been adapted for simple and radical prostatectomy. In 2018, cadaver studies demonstrated that partial prostate gland excision was feasible using a single port transvesical approach. Here we present the case of a patient undergoing single port transvesical partial prostatectomy.
Methods: A patient with localized Gleason 3+4 prostate cancer in the left lateral peripheral zone diagnosed on MRI fusion prostate biopsy. The procedure was performed with intraoperative MRI fusion using the KOELISâ mobile fusion imaging platform. The following surgical steps were described: (1) anterograde bladder neck dissection, (2) endopelvic fascia incision, (3) unilateral vascular pedicle ligation, (4) partial DVC ligation, (5) lateral lobe excision, (6) Surgical margin assessment, (7) bladder neck reconstruction.
Results: The patient underwent an uncomplicated single port robotic partial prostatectomy with removal of the left lateral lobe and seminal vesical. Intraoperative frozen sections of medial and lateral margins were negative for malignancy. He was discharged after spending 3.8 hours in recovery and did not require narcotics at discharge. His foley catheter was removed on postop day 3 and he was fully continent within 7 days of foley removal. He had good erectile function preoperatively and was fully potent within seven days of surgery. 6 month follow up data shows a stable PSA of 0.88 and no lesions on prostate MRI.
Conclusions: Single port transvesical partial prostatectomy is feasible and safe in carefully selected men with localized prostate cancer. Close attention to ongoing postoperative follow up is imperative to determine long-term oncologic outcomes.
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