Single-port Robot-assisted Laparoscopic Radical Prostatectomy Through Different Approaches: Technique And Early Outcomes

Objective: Through this research,we introduce the surgical technology and experience of our multi-path single-port robot-assisted radical prostatectom y,and anal yze its short-term clinical efficacy.Methods: A review of 118 cases of multi-path sp-RALP performed b y a surgeon in the Department of Urology of Changhai Hospital from May 2018 to June 2020.There are 4 paths in total,including 3 cases transabdominal,92 cases transperitoneum,10 cases transperineum and 13 cases were transvesical.Summarize the surgical experience,intr oduce the surgical positions of each path,the required instruments,important steps and other related surgical techniques.Record the patient’s perioperative data,understand the postoperative PSA changes and urinary continence recovery of the patient thr ough follow-up,compare the perioperative data and follow-up with the routine multiple RALP patients performed by the same surgeon during the same period,and evaluate the short-term clinical practice of sp-RALP Efficacy.Results: All 118 patients underwen t single-port radical prostatectom y with the assistance of robots.There was no conversion to open or additional surgical ports during the operation.The median operation time is 90min(IQR: 70-110min).The transabdominal,transperitoneal,transperineal an d transvesical approaches are 115min(110-152min),87.5min(IQR: 60-100min),127.5min,respectivel y(IQR: 110-150min)and 80min(IQR: 70-100min).The median intraoperative blood loss was 77.5ml(IQR: 50-100ml),the transabdominal,extraperitoneal,transper ineal,and transvesical approaches were: 60ml(50-100ml),50ml(IQR: 50-75ml),125ml(IQR: 100-200ml),100ml(IQR: 50-100ml).All patients had no blood transfusion,and no serious intraoperative complications such as rectal injury occurred during the opera tion.One patient had urine leakage after the operation,and the wound opened after the stitches were removed in one patient and healed after conservative treatment.One patient developed a pelvic infection after being discharged from the hospital,and recovered after re-admission to antibiotics.Compared with conventional multi-port RALP,there was no statisticall y significant difference in sp-RALP’s operation time,intraoperative bleeding,PSM,postoperative PSA,and urinary continence recovery 3 months a fter surgery(P>0.05),and after the catheter was removed The rate of immediate urinary control was higher than that of conventional multi-port RALP,and the postoperative application of analgesics was less,and patients with sp-RALP on individual routes w ere discharged more quickl y after surgery.The difference was statisticall y significant(P<0.05).Conclusions: For surgeons with rich experience in robotic surgery,based on the existing Da Vinci si HD robotic platform,combined with a commerciall y available multi-channel laparoscopic approach s ystem as a single-port surgery channel,the implementation of multi-path sp-RALP is safe feasible.Sp-RALP surgery can shorten the postoperative hospital stay,reduce the postoperative analgesic consumption of patien ts,and increase the patient’s immediate urinary control rate after extubation.For low-risk prostate cancer patients without lymph node dissection,it is worth y of promotion.