The Transition Toward Opioid-sparing Outpatient Radical Prostatectomy: A Single Institution Experience With Three Contemporary Robotic Approaches

OBJECTIVE To evaluate for differences in the perioperative and early postoperative outcomes between three different contemporary approaches of robotic radical prostatectomy (RARP), namely Single-PortMETHODS Retrospective review was performed on 865 consecutive patients with localized prostate cancer who underwent SP-TV, SP-EP, and MP-TP RARP. SP-TV and SP-EP RARP were performed using the purpose-built SP robotic platform. All procedures were performed by a single, experienced robotic surgeon. Demographics, perioperative, and early postoperative data were collected from the prospectively-maintained database. Statistical analysis was performed with descriptive statistics as presented.RESULTS All SP cases were completed without any need for conversion or additional ports. When compared with MP-TP RARP, both SP-EP and SP-TV RARP were associated with significantly reduced length of stay (median, SP-TV 5.07 vs SP-EP 5.1 vs MP-TP 26.6 hours, P = < .05) and with most patients being discharged within 24 hours (SP-TV 92.3% vs SP-EP 84.6% vs MP-TP 30.4%, P = < .05). Postoperative analgesia requirements were significantly reduced following SP-TV RARP with 95% did not require opioid analgesia after discharge, as opposed to 77.6% and 12.1% of patients in the SP-EP and MP-TP RARP cohorts, respectively (P = < .05). Additionally, SP-TV RARP demonstrated the added benefit of a shorter Foley catheter duration of 4 days with an earlier return of urinary continence. CONCLUSION The localization of RARP, as facilitated by the SP robotic platform, provided the opportunity for enhanced postoperative recovery resulting in decreased length of admission and postoperative pain, which allowed for increasing adoption of opioid-sparing outpatient prostatectomy. UROLOGY 180: 140-150, 2023. (c) 2023 Elsevier Inc. All rights reserved.