Single Port Transvesical Robot Assisted Radical Prostatectomy

Abstract

Single-port (SP) transvesical (TV) robot-assisted radical prostatectomy (RARP) is an extraperitoneal approach that regionalizes surgery to the area of disease, therefore sparing surrounding tissues to promote a fast recovery and early return of functional outcomes. The technique is possible because of the narrow profile of the SP robotic arm, the fully wristed endoscope, and the double-jointed instruments. SP TV RARP is indicated in men with clinically localized prostate cancer. The access to the bladder is obtained in an open fashion through a 3.5 cm midline incision. Once the patient cart is docked, the console surgeon dissects the prostate in the following order: posterior bladder neck, vas deferens and seminal vesicles, anterior bladder neck, neurovascular pedicles, and apex. Subsequently, the urethra is transected, and the prostatic specimen is extracted. At this point, a limited pelvic lymph node dissection can be done in the obturator fossa of each side. Finally, a vesicourethral anastomosis is performed starting with a posterior reconstruction and suturing bilaterally toward the anterior portion of the bladder neck. In our experience of 210, all cases have been performed successfully without conversion or the use of additional ports. There was minimal blood loss (median 70 mL). The median console time was two hours. Most patients underwent nerve-sparing procedures (87.1%). Lymph node dissection was done in 22.4% of cases with a median node yield of four. Ninety-two percent of planned outpatient cases were discharged in < 24 hours with a median length of stay of 4.7 hours, low pain scores, and 96.2% without an opioid prescription. This video article aims to provide a detailed description of the updated surgical technique, discuss special scenarios, and present updated outcomes from a large series of SP TV RARP cases.