Journal article
Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience
Journal of endourology, Vol.36(12), pp.1551-1558
12/01/2022
DOI: 10.1089/end.2022.0330
PMCID: PMC9718430
PMID: 36017625
Abstract
Background: We aimed to compare three robot-assisted radical prostatectomy (RARP) approaches-Retzius sparing (RS), extraperitoneal (EP), and transperitoneal (TP)-performed at our institution using the da Vinci (R) single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA).
Materials and Methods: We retrospectively reviewed the records of 101 patients who underwent SP-RARP at our institution and stratified them into three cohorts based on the RARP approach: RS (n = 32), EP (n = 30), and TP (n = 39). Data regarding preoperative patient characteristics, perioperative characteristics, oncologic outcomes, and early functional outcomes were collected. The Fisher's exact test and chi-square tests were utilized for categorical variables, and the Kruskal-Wallis test was utilized for numerical variables. Wilcoxon rank-sum tests were utilized for pairwise comparisons. A two-tailed p < 0.05 was considered significant.
Results: All three cohorts were largely similar in terms of preoperative patient characteristics. Operative time was significantly different between cohorts (p < 0.001), with the RS approach having a faster mean operating time than the TP approach (208 +/- 40 minutes vs 248 +/- 36 minutes, p < 0.001). Clinically significant margin rates did not differ significantly between cohorts (p =0.861). Postoperative continence differed significantly between cohorts (p < 0.001); higher continence rates were observed in RS vs EP-94% (30/32) vs 52% (15/29), respectively, p < 0.001. Return of erectile function also differed significantly between cohorts (p = <0.001); higher erectile function recovery rates were observed in RS vs EP-88% (28/32) vs 41% (11/27), respectively, p < 0.001-and in RS vs TP-88% (28/32) vs 60% (22/37), respectively, p = 0.014. Median (IQR) follow-up time was 150 (88-377) days.
Conclusions: RS SP-RARP is associated with improved early functional outcomes when compared with both EP and TP approaches. These benefits are achieved while maintaining equivalent oncologic outcomes. Further research is needed to optimize the patient selection paradigm for the SP-RARP approach.
Details
- Title: Subtitle
- Comparison of Three Approaches to Single-Port Robot-Assisted Radical Prostatectomy: Our Institution's Initial Experience
- Creators
- Shiva Balasubramanian - University of Missouri–Kansas CityAlexander Shiang - Washington University in St. LouisJoel M. Vetter - Washington University in St. LouisGrant M. Henning - Washington University in St. LouisR. Sherburne Figenshau - Washington University in St. LouisEric H. Kim - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.36(12), pp.1551-1558
- DOI
- 10.1089/end.2022.0330
- PMID
- 36017625
- PMCID
- PMC9718430
- NLM abbreviation
- J Endourol
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Publisher
- Mary Ann Liebert, Inc
- Number of pages
- 8
- Grant note
- UL1 TR002345; KL2 TR002346; TL1 TR002344 / National Center for Advancing Translational Sciences at the National Institutes ofHealth
- Language
- English
- Date published
- 12/01/2022
- Academic Unit
- Urology
- Record Identifier
- 9984949174702771
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