Single-port robot-assisted laparoscopic radical prostatectomy through different approaches: initial experience and outcomes / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the feasibility and effectiveness of sing-port robot-assisted laparoscopic radical prostatectomy(sp-RALP) through different approaches.Methods:The data of 115 patients who underwent sp-RALP through different approaches from May 2018 to June 2020 were retrospectively reviewed. In our study, 92 cases through extraperitoneal approach, 10 through transperineal approach and 13 though transvesical approach. Preoperative, intraoperative and early postoperative outcomes after various approaches were collected and analyzed. The mean age was 67(52-84) years, mean preoperative body mass index was 24.44(19.52-32.33) kg/m 2. Patients were graded as cT 1-3aN 0M 0 with no signs of regional lymph node invasion or distal metastasis. The median preoperative PSA was 9.77(6.54, 15.32) ng/ml. Results:All 115 sp-RALP were successfully completed with no conversion to open surgery or additional ports being placed. The mean operative time was 91.8(40-200)min, with 88.0(40-200)min for extraperitoneal approach, 132.5 (90-190)min for transperineal approach and 87.3(60-150)min for transvesical approach. The mean estimated blood loss was 85.5 (45-400)ml, with 77.6(50-200)ml for extraperitoneal approach, 178.0(80-400)ml for transperineal approach and 70.4 (45-150)ml for transvesical approach. Of the 115 patients, 60.9% (70/115)were <pT 3a, 39.1%(45/115) were ≥pT 3a. Positive margin(PSM) rate was 17.4%(20/115), with 31.1%(14/45) for ≥T 3a group, 8.6%(6/70) for <T 3a group. Postoperative pathology revealed a Gleason score of 3 + 3 in 6 patients, 3 + 4 in 45 patients, 4+ 3 in 52 patients, and ≥8 in 2 patients. Mean hospital stay was 3(1-7)d. Median postoperative PSA was 0.03(0.01, 0.05)ng/ml at 1 month postoperatively, and 88.7% patients reported less than 1 pad per day at 3 month postoperatively. Conclusions:With several advantages, such as better cosmesis, postoperative fewer pain, and better recovery as well as comparable oncological outcomes in the short-term follow-up, sp-RALP through various approaches is a feasible and effective procedure for organ-confined prostate cancer.