Comparative Study On Clinical Efficacy Of Robot-assisted Radical Prostatectomy With Modified Single Incision Approach And Transperitoneal Approach

Background and Objective: The global incidence of prostate cancer(PCa)continues to increase in recent years.Robot-assisted laparoscopic radical prostatectomy(RARP)has become the standard procedure for the treatment of PCa.Robotic surgery in China started late,but at present,many scholars have done some exploration in RARP surgery.Single-port Robot-assisted Laparoscopic Radical Prostatectomy(sp-RARP)is widely used in China and is developing rapidly.Traditional sp-RARP requires the use of special Single-port equipment: commercial PORT to establish intraoperative operating space to help solve space constraints and other problems,but it also increases the total hospitalization costs.Since November 2020,our center began to carry out extraperitoneal(EP)single-incision modified RARP without special PORT.Nearly 300 cases of PCa surgery have been completed with satisfactory results.This study will compare the clinical efficacy of modified single-incision EP-RARP and transperitoneal approach(TP)multi-incision RARP,and explore the clinical efficacy of this innovative technique in the treatment of PCa.Methods: In this study,the clinical data and postoperative recovery of patients who received modified single-incision RARP and TP-RARP were reviewed,and the general data,intraoperative conditions and postoperative recovery of patients who received modified single-incision RARP(n=238)and TP-RARP(n=125)were analyzed retrospectively.According to the different surgical methods,the patients were divided into two groups: modified single-incision RARP and TP-RARP,and the clinical effects of modified single-incision RARP were compared.Results: Surgical procedures were successfully performed in a total of 363 patients.There was no significant difference between the two groups in terms of age,Prostate specific antigen(PSA)level,serum alkaline Phosphatase(ALP),serum calcium,preoperative ISUP grade,prostate volume,history of lower abdominal operation,preoperative blood loss of clinical tumor lymph node metastasis(c TNM),positive rate of incision margin,postoperative recurrence rate,postoperative complications and urine control recovery.There were significant differences in operation time,postoperative indwelling catheter time,postoperative exhaust time,postoperative hospital stay and total hospitalization expenses(P < 0.05).Conclusion: Compared with TP-RARP,modified single incision RARP is equally safe and feasible,and there is no statistical difference in the positive rate of postoperative incisal margin,postoperative recurrence and the recovery of urine control function.The patients with modified single incision RARP have shorter operation time,and the postoperative anal exhaust days,postoperative catheter indwelling days and postoperative hospitalization days are more advantageous than those receiving TP-RARP operation.There is no significant difference in clinical efficacy between modified single-incision RARP and TP-RARP,and it is also safe and feasible,but its long-term effect needs to be further verified by more other centers and prospective studies.