Solving clinical challenges in prostate cancer using the single-port robot system

Objective: Patients who desire or require surgical management for prostate cancer, but are poor candidates for multi-port robotic surgery, can present a clinical challenge. Use of single port (SP) robotic technology may help overcome these challenges. We present our initial experience with robotic-assisted radical prostatectomy (RARP) using the da Vinci SP robot for prostate cancer in patients who would otherwise not be good surgical candidates for conventional multi-port transabdominal robotic surgery. Patients and surgical procedure: Fourteen of 41 patients who underwent SP-RARP from November 2020 to February 2022 for biopsy confirmed, organ-confined prostate adenocarcinoma at a single tertiary care institution qualified for inclusion in our study due to specific considerations posing challenges for conventional multiport transperitoneal RARP. Perioperative metrics, pathologic findings and functional outcomes were collected prospectively. The accompanying video shows two cases demonstrating our transvesical and extraperitoneal approaches to SP-RARP. Results: All patients underwent successful procedures without need to convert to multi-port robotic or open approach. Most patients had prior abdominal surgery (13/14, 93%) including aborted multi-port RARP (2), hernia repairs (5), bowel diversions (3), and peritoneal dialysis catheters (2) among others. Most underwent extraperitoneal (9/14, 64%) followed by transvesical (5/14, 36%) approach. There were no intraoperative complications and one Clavien III post-operative complication. Positive margin rate was 29%, most of which were microscopic (≤3 mm, 3/4, 75%). Eighty-five percent of patients had undetectable nadir PSA. Conclusions: Our initial experience using the SP robot suggests that this technology can facilitate surgery for prostate cancer patients who might otherwise not be considered surgical candidates. Operative outcomes are not compromised despite a smaller incision and working space. We have found the SP system to be a valuable tool for carefully selected patients.