Single port transvesical simple prostatectomy: A minimally invasive technique in BPH management

Abstract

Objectives: To present the updated technique and evaluate the perioperative outcomes of Single-port Robotic-assisted transvesical simple prostatectomy (SP RASP) Patients and methods: Forty-two consecutive patients with BPH indicated for surgery underwent SP RASP in a single institution. The procedure was performed in the following steps: 1- The Patient was placed in a supine position. 2- A 3-3.5 cm suprapubic midline incision is made, and a 2 cm vertical cystotomy was performed after bladder identification. 3- After insertion of the access port, the single-port (SP) robot was docked. 4- Identification of the ureteral orifices. 5- Prostatic enucleation was performed using the prostatic capsule as a landmark. 6- Then a complete vesicourethral mucosal advancement flap was accomplished. Results: All procedures were successfully performed with no conversion, additional port placement, or intraoperative complication. The median prostatic volume was 170cc. 95% of the patients did not require opioid analgesia after discharge. 65% of the last consecutive patients were discharged a few hours after the surgery and had their Foley catheter removed 2-3 days later. The Median IPSS score decreased from 23 before the surgery to 2.5 after the surgery. All patients had a significant postoperative improvement in maximum flow rate with a 200% improvement over baseline (19 vs. 6.5 mL/sec). Conclusion: In our initial series, SP RASP allows for favorable perioperative and early postoperative outcomes including low complication same-day discharge, short Foley catheter stay, minimal opioids use, and quick recovery.

Keywords

• Benign prostatic hyperplasia
• Prostatectomy
• Robotic-assisted surgery
• Urologic surgical procedures
• Single-port surgery