TY - JOUR
T1 - Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy
T2 - Our Institution's Initial Experience
AU - Balasubramanian, Shiva
AU - Shiang, Alexander
AU - Vetter, Joel M.
AU - Henning, Grant M.
AU - Figenshau, R. Sherburne
AU - Kim, Eric H.
N1 - Publisher Copyright:
© Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches - Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP) - performed at our institution using the da Vinci® single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). Materials and Methods: We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS (n = 32), EP (n = 30), and TP (n = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed p < 0.05 was considered significant. Results: All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts (p < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 ± 40 minutes vs 248 ± 36 minutes, p < 0.001). Clinically significant margin rates did not differ significantly between cohorts (p = 0.861). Postoperative continence differed significantly between cohorts (p < 0.001); higher continence rates were observed in RS vs EP - 94% (30/32) vs 52% (15/29), respectively, p < 0.001. Return of erectile function also differed significantly between cohorts (p = <0.001); higher erectile function recovery rates were observed in RS vs EP - 88% (28/32) vs 41% (11/27), respectively, p < 0.001 - and in RS vs TP - 88% (28/32) vs 60% (22/37), respectively, p = 0.014. Median (IQR) follow-up time was 150 (88-377) days. Conclusions: RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.
AB - Background: We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches - Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP) - performed at our institution using the da Vinci® single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). Materials and Methods: We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS (n = 32), EP (n = 30), and TP (n = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed p < 0.05 was considered significant. Results: All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts (p < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 ± 40 minutes vs 248 ± 36 minutes, p < 0.001). Clinically significant margin rates did not differ significantly between cohorts (p = 0.861). Postoperative continence differed significantly between cohorts (p < 0.001); higher continence rates were observed in RS vs EP - 94% (30/32) vs 52% (15/29), respectively, p < 0.001. Return of erectile function also differed significantly between cohorts (p = <0.001); higher erectile function recovery rates were observed in RS vs EP - 88% (28/32) vs 41% (11/27), respectively, p < 0.001 - and in RS vs TP - 88% (28/32) vs 60% (22/37), respectively, p = 0.014. Median (IQR) follow-up time was 150 (88-377) days. Conclusions: RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.
KW - outcomes research
KW - prostatectomy
KW - robot-assisted surgery
UR - http://www.scopus.com/inward/record.url?scp=85141041435&partnerID=8YFLogxK
U2 - 10.1089/end.2022.0330
DO - 10.1089/end.2022.0330
M3 - Article
C2 - 36017625
AN - SCOPUS:85141041435
SN - 0892-7790
VL - 36
SP - 1551
EP - 1558
JO - Journal of Endourology
JF - Journal of Endourology
IS - 12
ER -