(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL between April 28 and May 1st, 2023, was host to the Arab Association of Urology sectional session. Dr. Jihad Kaouk discussed the latest and most important technical aspects of single port (SP) robotic assisted radical prostatectomy.
Dr. Kaouk began his presentation by acknowledging that the uptake of the robotic SP approach has been modest. He argued that this is likely due to limited, incremental benefits seen in the transition from multiport (MP) to the SP approach. While we saw significant clinical benefits in going from open to laparoscopic surgery and then from laparoscopy to the robotic MP, this “net” improvement is not as pronounced in this latest transition from MP to SP robotics.
Dr. Kaouk emphasized that the benefit of an MP approach is not limited to improved cosmesis, but also allows for the minimization of narcotics, allows for regionalization of surgery, eliminates the need for Trendelenburg positioning, and decreases the pneumoperitoneal requirements, all while improving patient comfort. He highlighted that this is not an “all or none” approach but further adds to the robotic surgeon’s armamentarium, whereby the regionalized access afforded by the SP robot could be leveraged to the patient/surgeon’s advantage in select cases.
The SP platform offers multiple advantages per Dr. Kaouk:
- It has a narrow profile via one cannula (25 mm) that affords surgical manipulation limited to the organ of interest
- Does not require Trendelenburg positioning, which reduces ventilation requirements for obese patients or those with COPD and avoids high intra-ocular pressures
- Allow for a single scar with reduced pain allowing for a non-narcotic post-operative approach leading to a faster recovery
While a transperitoneal approach remains standard, the SP platform allows for numerous other approaches to prostate surgery:
- Extraperitoneal
- Transvesical
- Perineal
He highlighted cases of patients with multiple prior abdominal surgeries with ‘hostile’ abdomens. He argued that by regionalizing the surgery with the SP platform via any of the aforementioned approaches, a radical prostatectomy in these patients would become feasible. Each of the aforementioned non-transperitoneal approaches has its unique advantages and patient selection criteria:
At this point, Dr. Kaouk gave a brief illustrative overview of the SP transvesical approach, depicted in the figures below:
Dr. Kaouk and colleagues have recently published on their experience with the SP transvesical approach (n=190), highlighting the following:
- Positive margin rates: 17%
- 77% of which were limited (<3 mm)
- Length of stay: median of 5 hours
- 90% were outpatient
- Use of narcotics
- Inpatient MMR: 7.5 mg
- Only 5% required narcotics at discharge
He also highlighted the improved early continence outcomes for patients undergoing a SP transvesical approach, with 47% of patients in this group reportedly experiencing immediate continence.
Limited clinical improvements were observed in the SP transperineal versus MP robotic approach, as summarized in the table below:
Dr. Kaouk concluded his presentation by highlighting the “multi”-dimensional value of SP robotic surgery as summarized below:
Presented by: Jihad Kaouk, MD, Professor, Department of Urology, Cleveland Clinic, Cleveland, OH
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023