Single-Port Retzius-Sparing Robot-Assisted Radical Prostatectomy: Feasibility and Early Outcomes

To determine safety and feasibility of single-port Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci^® SP (Intuitive Surgical, Sunnyvale, CA) robotic platform in men with adenocarcinoma of the prostate. Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for perioperative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. Mean (standard deviation) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m². Mean preoperative prostate-specific antigen (PSA) was 10.2 ng/mL. Average prostate weight was 42 g. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in 24 (86%) patients and nerve sparing in 14 (46%) patients. Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for postoperative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration and dilation of bladder neck contracture). Pathologic grade group was group 1 (0%), group 2 (57%), group 3 (29%), and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA during follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Postoperative mean sexual health inventory for men score in those who underwent nerve sparing was 18 at 3 months follow-up. SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes requires longer follow-up and larger cohort validation.