Single-port transvesical robotic radical prostatectomy: Description of technique

Abstract

Objective: To describe the surgical steps of single-port robotic radical prostatectomy through the transvesical approach. Methods: Through a 3 cm suprapubic midline incision, the bladder was entered and the Da Vinci Single-Port Access Kit was used for access. Through the access kit, the dedicated multichannel port, an 8 mm assistant port, and the remotely operated suction irrigation system were introduced. The surgical steps for transvesical radical prostatectomy were performed in the following order. (1) Posterior bladder neck dissection, (2) Vas deferens and seminal vesicle dissection, (3) Posterior dissection, (4) Anterior bladder neck and prostate dissection, (5) Pedicle and neurovascular bundle dissection, (6) Posterior Reconstruction and Urethrovesical Anostomosis, (7) removal of the prostate through a single incision and bladder closure. Results: The mean patients’ age was 62 years and the mean preoperative prostate-specific antigen (PSA) was 6.8 ng/mL. Single port robotic transvesical radical prostatectomy was performed successfully in 83 patients without the need for additional port placement or open conversions. The average operative time was 212 min. The mean estimated blood loss was 115 mL. The median length of stay was 4 h. Median time with a Foley catheter after surgery was 4 days. 56% of the patients had immediate continence after Foley removal. The continence rate was 96.7% at postoperative 3 months. Conclusion: SP transvesical robotic radical prostatectomy is a novel approach that provides advantages including a single incision, no additional ports, minimal opioid use, immediate continence, and same-day discharge without compromising intraoperative and oncological outcomes.

Keywords

• Prostate cancer
• Prostatectomy
• Robotic-assisted surgery
• Single-port
• Laparoendoscopic single-site