Abstract: Extraperitoneal Single-Port Robotic-Assisted Radical Prostatectomy

Robotic-assisted radical prostatectomy (RARP) has become a mainstream minimally invasive treatment for prostate cancer (PCa). Although single-port robotic-assisted radical prostatectomy (spRARP) was first reported in 2008, its clinical application has been limited by technical drawbacks including restricted working space and frequent instrument collision via the traditional transumbilical approach. A clinical study explored the safety and feasibility of extraperitoneal single-port RARP (espRARP) using the da Vinci Si HD system with a commercial 100-mm multi-channel laparoscopic port from Senscure .

Illustration of Extraperitoneal single-port robotic-assisted radical prostatectomy. (A) Abdominal incision and port placement, showing a 5 cm transverse incision approximately 5 cm above the pubic symphysis, with a wound protector placed extraperitoneally. (B) Intra-operative installation, showing a quadrichannel port installed with two robotic arms, and a camera facing 30-degree up installed at the caudal side, with the cephalad port used as the assistant's port. (C) Wound closure with a Jackson-Pratt drainage placed in the same incision.

The study retrospectively analyzed 19 patients with organ-confined PCa. All surgeries were completed successfully without open conversion or additional port placement, with a median operative time of 95.0 minutes and minimal estimated blood loss. No severe perioperative complications of Clavien grade III or above occurred, and the median postoperative hospital stay was 3 days. Benefiting from optimized incision location and adjustable 30° upward laparoscope visualization, the modified espRARP effectively reduced robotic arm collision and improved surgical triangulation.

Functional outcomes were favorable: the 6-month continence recovery rate reached 100% among evaluable patients. As an extraperitoneal single-port technique, espRARP avoids extreme patient positioning and reduces intra-abdominal adhesion risks, making it suitable for patients with a history of abdominal surgery.

Source: Initial experience on extraperitoneal single-port robotic-assisted radical prostatectomy

【 https://pmc.ncbi.nlm.nih.gov/articles/PMC7817323/ 】