Introduction:

In recent years, the introduction of the purpose-built Single-Port (SP) robotic platform (Intuitive Surgical, Sunnyvale, CA) have allowed for the development of a more regionalized approach to robotic radical prostatectomy (RARP), such as with the advent of the Transvesical approach. The novel technique provided the opportunity for an enhanced postoperative recovery with most patients able to be discharged on the same day without requiring any opioids and with many achieving earlier return of urinary continence. Despite these benefits, there remains limited evidence on the impact of this novel technique on the pathologic and oncologic outcomes, which we sought to evaluate in this present study.

Methods:

A retrospective review was performed on prospectively collected data of 169 patients who underwent SP Transvesical or Multi-Port (MP) Transperitoneal RARP by a single surgeon between 2015 and 2022. All SP Transvesical cases were completed entirely from within the bladder using the purpose-built SP platform with all instruments inserted through the multichannel cannula of the dedicated SP Access Kit (Intuitive Surgical, Sunnyvale, CA) via a single 3.5cm suprapubic incision. Preoperative clinicopathologic characteristics, as well as final histopathology outcomes, were compared. Univariate Cox proportional hazard analysis was used to evaluate the impact of the surgical approach on biochemical recurrence-free survival within 12 months. 

Results:

SP Transvesical and MP Transperitoneal RARP were completed in 85 and 84 patients, respectively. Preoperative clinicopathologic and prostatectomy histopathologic features were similar between the two groups. The two approaches were associated with identical positive surgical margin rates (SP 20% vs. MP 26%, p=0.36). At a median follow-up of 12 months, there were no differences in the rates of biochemical recurrence between the groups (p=0.38). Univariate Cox proportional hazard analysis did not consider surgical approach to be an independent predictor of biochemical recurrence (HR 0.53, 95%CI 0.13–2.23, p=0.39).

Conclusion:

SP Transvesical RARP provided a similar short-term oncologic control as the gold standard MP approach with similar surgical margin status and 1-year biochemical recurrence rates.

Funding: N/A