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Extraperitoneal single‐port robot‐assisted radical prostatectomy: initial experience and description of technique
Author(s) -
Kaouk Jihad,
Valero Rair,
Sawczyn Guilherme,
Garisto Juan
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14885
Subject(s) - medicine , prostatectomy , surgery , dissection (medical) , lithotomy position , supine position , trendelenburg position , umbilicus (mollusc) , perioperative , port (circuit theory) , foley catheter , robotic surgery , balloon , da vinci surgical system , laparoscopic radical prostatectomy , prostate cancer , catheter , cancer , alternative medicine , pathology , electrical engineering , engineering
Objective To describe our technique of extraperitoneal single‐port (SP) robot‐assisted radical prostatectomy (RARP) and present our clinical experience with the first 10 cases. Patients and Methods In all, 10 consecutive patients diagnosed with localised prostate cancer underwent extraperitoneal SP‐RARP using the da Vinci SP® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Exclusion criteria included previous surgery through an infra‐umbilical midline incision, prostate size >100 g, or preoperative evidence of extraprostatic disease. All surgeries were performed by a single surgeon with previous experience of >3000 cases in robotic surgery. Demographics and perioperative information were collected including: operative time, estimated blood loss (EBL), complications, length of stay, and days with Foley catheter. The extraperitoneal SP‐RARP is performed as follows. Firstly, a 3‐cm incision ~2 cm below the umbilicus is made. Dissection of the extraperitoneal space is achieved using a kidney shaped Spacemaker™ balloon (Covidien, Dublin, Ireland), placed through the infra‐umbilical incision caudally reaching the retropubic space. Thereafter, the balloon is deployed; the space is created and verified under direct vision with a laparoscopic endoscope. A Gel POINT® mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA , USA) is inserted and a dedicated 25‐mm multichannel port is placed with a 12‐mm accessory laparoscopic port through the gel‐seal cap into the same incision. The da Vinci SP surgical platform robot is docked with the patient in a supine position. RARP is performed replicating the technique previously described for multi‐arm platforms or transperitoneal SP‐RARP. No drain and no additional assistant ports were utilised. Results The patient's ages ranged between 48 and 70 years, and the mean preoperative prostate‐specific antigen (PSA) level was 9 ng/mL. No conversions or intraoperative complications were recorded. The median (interquartile range) operative time was 197.5 (185.5–229.7) min. EBL ranged between 50 and 400 mL, six patients were discharged on the same day as the surgery and the median time with a Foley catheter after surgery was 8 days. Conclusions Extraperitoneal SP‐RARP is a feasible and safe surgical option to treat localised prostate cancer. In our early experience, promising results and possible advantages were found such as: a small single incision, no additional ports, no Trendelenburg positioning, minimal postoperative pain and use of opioids, and same day discharge. Further investigations need to be done to validate these advantages.