Adoption of Single-Port Robotic Prostatectomy: Two Alternative Strategies

Objective: To demonstrate two distinct methods for adopting the single-port (SP) robotic surgery system for robotic-Assisted laparoscopic prostatectomy (RALP) by two experienced robotic surgeons (J.D. and R.A.) and evaluate early outcomes with each strategy. Methods: The initial RALP procedures using the SP robot by two surgeons were reviewed from prospective data collection at two institutions, MD Anderson Cancer Center (MDA) and OhioHealth Dublin Methodist Hospital (DMH). Both teams adopted different strategies regarding patient selection criteria, surgical approach, use of assistant ports, performance of lymphadenectomy, postoperative discharge criteria, and having a backup robot on standby. Results: The initial 74 consecutive patients who underwent SP-RALP at MDA and DMH (n = 34 and n = 40, respectively) were reviewed. All DMH and 24 MDA patients underwent a transperitoneal (TP) approach, whereas 10 MDA patients underwent an extraperitoneal (EP) approach. Mean operative time was similar for MDA and DMH, although it was shorter in TP patients. All MDA patients underwent nerve-sparing procedures and 12% underwent pelvic lymph node dissection (PLND); however, at DMH, all patients had PLND and 55% had nerve sparing. Mean estimated blood loss was not clinically significant for either group. Length of stay was 1.1 days (range, 1-2 days) for MDA and 0.12 days (range, 0-1 day) for DMH. No major complications occurred in either group other than two lymphoceles requiring percutaneous drainage in the EP SP-RALP group. Conclusion: Two significantly different strategies for SP robot adoption allowed immediately safe and equally efficacious outcomes in the initial patients treated.