Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Radical prostatectomy is a standard treatment for localized prostate cancer.
• Single-port (SP) surgery offers potential advantages in minimally invasive procedures.
• Comparing extraperitoneal (EPRP) and transperitoneal (TPRP) approaches in SP radical prostatectomy is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare perioperative and early postoperative outcomes of single-port extraperitoneal radical prostatectomy (SP EPRP) versus single-port transperitoneal radical prostatectomy (SP TPRP).
• To evaluate the efficacy and safety of different SP approaches in robot-assisted radical prostatectomy.

Main Methods:

• Multi-institutional retrospective analysis of 650 patients undergoing SP robot-assisted radical prostatectomy.
• Propensity-score matched-pair analysis (1:1 ratio) was performed based on BMI, prostate size, and cancer risk.
• Perioperative and postoperative outcomes were analyzed using statistical tests (Wilcoxon, chi-square, Fisher's exact).

Main Results:

• After matching, 238 patients were analyzed in each group (SP EPRP vs. SP TPRP).
• SP EPRP had a longer operative time (206 vs. 155 minutes) but resulted in a shorter hospital stay and higher same-day discharge rate (P < .001).
• No significant differences were observed in intraoperative/postoperative complications or positive surgical margin rates between the two approaches.

Conclusions:

• The single-port extraperitoneal approach is associated with a shorter hospital stay and increased same-day discharge rates.
• SP EPRP demonstrates comparable surgical margin status and complication rates to SP TPRP.
• SP EPRP represents a viable alternative for minimally invasive radical prostatectomy with favorable early recovery outcomes.