Extraperitoneal Single-Port Robot-Assisted Radical Prostatectomy for a Massive Prostate: A Case Report

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Single-port robot-assisted radical prostatectomy (SP-RARP) offers a less invasive approach compared to multi-port RARP.
• A key limitation of SP-RARP is reduced instrument force, challenging manipulation of large organs like massive prostates (>100g).
• SP-RARP for prostates exceeding 100g is rarely reported due to these technical difficulties.

Observation:

• A 77-year-old male patient with significant prostatic hypertrophy (143g), bilateral ureteral stones, and prostate adenocarcinoma underwent extraperitoneal SP-RARP for urinary retention.
• The procedure was completed successfully via a 4.5 cm sub-umbilical incision with an operative time of 4 hours 40 minutes and estimated blood loss of 450 mL.
• No intraoperative complications were noted, and the patient experienced an uneventful postoperative recovery.

Findings:

• This case report highlights the successful execution of extraperitoneal SP-RARP in a patient with a massive prostate (143g).
• The study addresses and overcomes the technical challenge posed by the da Vinci SP system's limited retraction force in manipulating large prostates.
• This represents a documented instance of successful extraperitoneal SP-RARP for prostates over 100g, a procedure previously considered difficult and rarely reported.

Implications:

• The findings suggest that extraperitoneal SP-RARP can be safely and effectively performed even in cases with significantly enlarged prostates, provided appropriate techniques are employed.
• This successful case potentially expands the indications for SP-RARP, particularly in high-volume surgical centers.
• Further research and technique refinement could enhance the applicability of SP-RARP for a broader range of prostate sizes.