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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Published on: May 19, 2022

Two Arms-one Assisted Port Extraperitoneal Robot-assisted Radical Prostatectomy: A Simplified, Safe, Alternative

Yuh-Shyan Tsai¹, Pei-Hsin Lee², Yeong-Chin Jou³

¹Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.; youh@ncku.edu.tw.

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|June 29, 2026

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A simplified two-arm, one-assistant-port extraperitoneal robotic radical prostatectomy (RARP) is safe and cost-effective. This technique offers comparable outcomes to the three-arm approach with reduced operative time, potentially aiding single-port adoption.

Area of Science:

Urology
Surgical Oncology
Robotic Surgery

Background:

Robot-assisted radical prostatectomy (RARP) is standard for prostate cancer.
Conventional transperitoneal RARP has limitations including cost and complications.
A simplified extraperitoneal approach was developed to overcome these issues.

Purpose of the Study:

To evaluate a novel two-arm, one-assistant-port extraperitoneal RARP technique.
To compare its safety, efficacy, and cost-effectiveness against conventional methods.

Main Methods:

Retrospective analysis of 361 consecutive RARP procedures performed by a single surgeon.
Technique evolved from transperitoneal to extraperitoneal, and then to a two-arm configuration.
Comparison of baseline characteristics, lymph node yield, blood loss, operative time, and adverse events.

Keywords:

Robotic surgery cost-effective prostatectomy

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Main Results:

The two-arm extraperitoneal RARP showed comparable blood loss and lymph node yield to the three-arm approach.
Significantly shorter operative times were observed with the two-arm technique (p<0.0001).
Adverse events were low, with bowel ileus exclusively occurring in the transperitoneal group.

Conclusions:

The two-arm, one-assistant-port extraperitoneal RARP is a simplified, safe, and cost-effective surgical option.
This technique serves as a viable transition to single-port robotic systems.
It offers potential advantages for patients with prior abdominal surgery.