Initial case series and perioperative outcomes of single-port robotic radical prostatectomy: the Italian experience

The Da Vinci Single-Port Robotic System (Da Vinci-SP), introduced by Intuitive (CA, USA) in 2018 in the USA and in 2024 in Europe, integrates advanced features like a flexible camera and articulating instruments. It has garnered significant interest in urology. Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale" Foundation, detailing the technical differences and challenges faced by experienced multiport robotic surgeons.

Sixteen patients have been enrolled and underwent Single-Port (SP) Robot-Assisted Radical Prostatectomy (SP-RARP). Baseline characteristics of the patients were collected. We provided a step-by-step description of the surgical technique. Oncological outcomes have been evaluated and compared with magnetic resonance imaging (MRI) and biopsy results. Intraoperative, perioperative, and postoperative complications, surgical outcomes, functional outcomes, and technical issues of the new system were also documented.

All surgeries were successfully performed without the need for conversion. An extraperitoneal approach was used for all patients. Median Console time was 110 min. No complications were reported. The estimated median blood loss was 175 cc. Discharge from the hospital was on the first post-operative day for all patients. Bladder catheter removal was on day 7 without the need for cystography.

We presented the first European case series of SP-RARP, reporting our experience and confirming the procedure's feasibility for a highly experienced robotic surgeon. Experience with an extraperitoneal approach using the multiport (MP) platform, combined with well-conducted training for the SP system, may facilitate the transition to SP surgery. Further procedures and studies are needed to evaluate the oncological and functional outcomes.