Single Port Radical Prostatectomy as a Viable Option for Highly Complex Patients: A Single Center Experience

Greta Pettenuzzo; Francesco Ditonno; Donato Cannoletta; Luca Morgantini; Ruben Calvo Sauer; Juan R Torres-Anguiano; Francesco Montorsi; Alberto Briganti; Alessandro Veccia; Alessandro Antonelli; Simone Crivellaro

doi:10.1016/j.urology.2024.04.051

Single Port Radical Prostatectomy as a Viable Option for Highly Complex Patients: A Single Center Experience

Urology. 2024 May 7:S0090-4295(24)00349-2. doi: 10.1016/j.urology.2024.04.051. Online ahead of print.

Affiliations

¹ Department of Urology, University of Illinois at Chicago, Chicago, IL; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. Electronic address: gretapettenuzzo@gmail.com.
² Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Urology, Rush University, Chicago, IL.
³ Department of Urology, University of Illinois at Chicago, Chicago, IL; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
⁴ Department of Urology, University of Illinois at Chicago, Chicago, IL.
⁵ Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
⁶ Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

PMID: 38723951
DOI: 10.1016/j.urology.2024.04.051

Abstract

Objective: To explore the safety and feasibility of the Da Vinci single-port (SP) platform in robotic-assisted radical prostatectomy (SP-RARP), aiming to provide a viable option for patients with surgical and medical complexities that might otherwise limit their access to common minimally invasive technique.

Methods: Data from 60 medically and surgically highly complex patients undergoing SP-RARP between December 2018 and December 2023 were analyzed. Variables included patient characteristics, surgical history, intraoperative and postoperative outcomes. Statistical analysis was conducted using Stata 17.0.

Results: Fifty-three percent of cases had a hostile abdomen (HA) (≥1 major abdominal surgery), and 47% were medically highly complex (American Society of Anesthesiologists score ≥3, Charlson Comorbidity Index ≥5, and a body mass index ≥30). The extraperitoneal approach was used in 56% of HA cases and 68% of MHC cases. Intraoperative complications occurred in 12%, exclusively with the transperitoneal approach in HA cases. Postoperative complications (Clavien-Dindo ≥3) were 6% and 14%, respectively, with no significant difference between approaches. Same-day discharge was possible in 44% of HA cases and 54% of MHC cases, with significant statistical differences favoring the extraperitoneal approach in both groups.

Conclusion: SP-RARP, particularly the extraperitoneal approach, is a viable option for highly complex and challenging cases, providing acceptable oncological and functional outcomes. Prospective studies are crucial for further validating the safety and feasibility of SP-RARP in this patient population.