Single-Port Robotic Radical Prostatectomy: A Comparison Analysis of Three Common Approaches from the Single-Port Advanced Research Consortium (SPARC)
Recommended Citation
Soputro N, Ramos-Carpinteyro R, Sauer Calvo R, Moschovas MC, Manfredi C, Raver M, Okhawere K, Wang Y, Snajdar E, Pedraza A, Chavali JS, Mikesell CD, Lorentz A, Yuh B, Nix JW, Joseph J, Kim M, Rogers C, Nelson RJ, Stifelman MD, Ahmed M, Crivellaro S, Autorino R, Kaouk J. Single-Port Robotic Radical Prostatectomy: A Comparison Analysis of Three Common Approaches from the Single-Port Advanced Research Consortium (SPARC). J Endourol 2024; 38(S1):A95-A96.
Document Type
Conference Proceeding
Publication Date
8-1-2024
Publication Title
J Endourol
Abstract
Introduction: The Single-Port (SP) robotic platform was first introduced in 2018. The distinguishing features of the novel purpose-built platform, especially its narrow profile and doublejointed instruments, offered an improved manoeuvrability and ergonomics, especially when performing procedures in a shallow and smaller surgical working space. In the past few years, several approaches of SP robotic radical prostatectomy (RARP) have been introduced, including the Transperitoneal (TP), Extraperitoneal (EP), and the more regionalized Transvesical (TV) techniques. The aim of this study was to evaluate for the differences in perioperative outcomes between the three most used approaches of SP-RARP, based on a large multi-institutional series. Methods: A retrospective review was performed on the prospectively maintained, IRB-approved database of the Single- Port Advanced Research Consortium (SPARC) to identify all patients who underwent SP-RARP between 2018 to 2023. Baseline clinicodemographic, perioperative, and postoperative data were evaluated and categorized based on the three different approaches of SP-RARP. Statistical analysis was performed using R Packages for Statistical Computing with descriptive statistics as presented. Results: A total of 1867 patients were included, which comprised 568, 994, and 260 cases of TP, EP, and TV SP-RARP. Despite the similarities in age and BMI, history of previous abdominal surgery was more prevalent in the TV cohort (TP 13.2% vs. EP 31.2% vs. TV 49.3%, p < 0.05). Patients with higher-grade diseases who required pelvic lymph node dissections were more commonly referred for either TP or EP SPRARP. Intraoperatively, the TV approach was associated with the least amount of intraoperative blood loss and the need for additional ports. All procedures were completed successfully without the need for conversion. Intraoperative complications were identified in 2.2%, 0.7%, and 0.3% of the TP, EP, and TV cases, respectively. TV SP-RARP was associated with the shortest length of stay and reduced opioid prescription (median length of stay, TP 24 vs. EP 8 vs. TV 5.8 hours, p < 0.05; discharge opioid, TP 31.1% vs. EP 31.9% vs. TV 7.9%, p < 0.05%). The 90-day rates of postoperative complication (p = 0.144) and hospital readmission (p = 0.127) remained comparable across all three approaches. At a median follow-up duration of 12 months, an earlier return of urinary continence was achieved following TV SP-RARP and oncological outcomes remained favorable across the three groups. Conclusions: Herein, we reported the outcomes of three contemporary approaches of SP-RARP, with added values towards enhancing patient comfort and postoperative recovery. Compared with the other techniques, the TV approach was associated with a significantly reduced length of stay, opioid requirements, major postoperative complication, as well as an earlier return of urinary continence.
Volume
38
Issue
S1
First Page
A95
Last Page
A96
