Comprehensive Outcome Analysis of Single-Port Robot-Assisted Radical Prostatectomy

Abstract

Background:

Robot-assisted radical prostatectomy (RARP) is the most common surgical approach in the management of localized prostate cancer. Early evidence suggests that single-port (SP) RARP is a safe and feasible alternative to the conventional multiport (MP) RARP. We compared the perioperative and functional outcomes of SP vs MP RARP performed by a single high-volume robotic surgeon, assessing the efficacy of SP RARP in an academic setting.

Methods:

We retrospectively analyzed data from 145 consecutive patients who had undergone SP RARP performed by a single surgeon after the initial adoption of this technique. Continence and potency were evaluated at 3 and 6 months postoperatively. After propensity score matching (PSM), outcomes were compared with a historical cohort of patients who had undergone MP RARP performed by the same surgeon.

Results:

The median estimated blood loss (EBL) was 200 mL (100–300), and the median operative time (OT) was 210 minutes (180–240). Most patients showed intermediate Gleason risk (3 + 4, n = 99, 68.3%; 4 + 3, n = 30, 20.7%). When compared with the MP cohort after PSM, there were no differences in EBL and a positive surgical margin rate (p = 0.749 and 0.194, respectively). SP RARP patients showed longer OT (p = 0.007) and lower early continence rate after operation (3 months, 47.2% vs 65.9%, p = 0.003; 6 months, 55.3% vs 82.9%, p < 0.001) compared with patients who underwent MP RARP. The majority of the SP RARP patients were discharged on the day of operation.

Conclusion:

In this single-surgeon series, EBL and surgical margin positivity rate were similar between the SP and MP groups. However, OT was longer, and early continence rates were worse in the SP group. These findings suggest that SP RARP may yield suboptimal functional outcomes in the initial phase of the learning curve.