Perioperative outcomes of single-port vs multi-port robotic-assisted radical prostatectomy: A multicentric propensity score matched analysis
Recommended Citation
Bertini A, Finocchiaro A, Vigano S, Almajedi M, Savannah G, Parker A, Tinsley S, Snajdar E, Mazur G, Laouters M, Matynowski A, Gandaglia G, Nelson R, Lughezzani G, Buffi N, Di Trapani E, Ficarra V, Salonia A, Briganti A, Montorsi F, Rogers C, Abdollah F. Perioperative outcomes of single-port vs multi-port robotic-assisted radical prostatectomy: A multicentric propensity score matched analysis. Eur Urol 2025; 87(S1):1448.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Since the FDA's approval in 2018, the use of Single Port (SP) Robotic-assisted-radical-prostatectomy (RALP) has rapidly spread in the US. However, exhaustive evidence about SP-RALP peri-operative outcomes is still lacking. We aimed to compare SP-RALP and Multi-Port (MP) in terms of perioperative outcomes in a matched cohort. Materials & Methods: We included 4384 patients who underwent SP or MP-RALP for Prostate cancer (PCa) at two tertiary care centers. All the SP-RALP and the MP-RALP were performed at Henry Ford Health (HFH) and IRCCS San Raffaele Hospital, respectively. Propensity score matching [PSM: age, Body Mass Index (BMI), Charlson Comorbidty Index (CCI), prostate specific antigen (PSA) at surgery, grade group (GG) at biospy and clinical T stage] was used to balance the differences between the two groups. Next, in the matched cohort, logistic regression tested the impact of surgery type on following endpoints: estimated blood loss (EBL) above median, operating time above median, post-operative complications rate and positive surgical margins (PSM). Linear regression tested the impact of surgery type on Length of stay (LOS). Results: Our final 1:3 PSM matched cohort consisted of 236 patients who underwent RALP, 59 (25%) of whom underwent SP-RALP. Median age at surgery (IQR) was 64 (59-69) years. No significant differences in terms of age, BMI, previous prostate surgery, CCI, PSA at surgery, GG at biopsy and clinical T stage were reported between the two groups. Patients who underwent SP-RALP were less likely to undergo Pelvic Lymph Node Dissection (PLND) (77%vs 90%, p=0.01), reporting less median nodes removed (9 vs 14, p<0.001), lower median prostate volume (39 vs 51 g, p<0.001) and GG <3 PCa (85% vs 71%, p=0.03). Patients undergoing SP-RALP had an increased PSM rate (57%vs 24%, p<0.001), decreased median EBL (58 vs 200 ml, p<0.001) and decreased median LOS (0 vs 6 days, p=0.002), compared to MP-RALP. At MVA, SP patients had lower EBL (OR: 0.01, p<0.001), shorter operative time (OR: 0.39, p=0.03), decreased LOS ((3: -4.8, p<0.001), and higher PSM rate (OR: 3.70, p=0.001), than their MP counterparts. Conversely, no correlation was found between SP-RALP and post-operative complications (OR: 2.07, p=0.09). Conclusions: Our results showed that SP-RALP, despite being characterized by increased PSM, appears to ensure reduced EBL, operative time and a shorter LOS, with no differences in terms of postoperative complications compared to MP-RALP. Considering that the SP cases captured in this cohort represent the initial learning curve, future results might be even more promising.
Volume
87
Issue
S1
First Page
1448
