Single-port Transvesical Robot-Assisted Simple Prostatectomy: Surgical Technique and Clinical Outcomes

Background: Surgical management of large prostatic adenomas can be performed via open, endoscopic, or robotic approaches. A low -profile single -port (SP) robot was built to work in confined areas (ie, the bladder) and regionalize surgery.<br /> Objective: To describe the novel SP transvesical (TV) robot -assisted simple prostatectomy (RASP) and report clinical outcomes.<br /> Design, setting, and participants: SP TV RASP cases were performed in an academic hospital by two surgeons from 2019 to 2023. A total of 117 cases were performed, and data from patients with at least 12 mo of follow-up were analyzed. The inclusion criterion was severe obstructive urinary symptoms or catheter -dependent urinary retention due to large prostates with volume >80 ml.<br /> Surgical procedure: The procedure consisted of two main steps through a single 3 -cm suprapubic incision: first, enucleation of the adenoma, and second, a 360 degrees bladder mucosal flap reconstruction. No drains or continuous bladder irrigation was used routinely. Measurements: Intraoperative parameters, pre- and postoperative uroflowmetry, and 1-yr clinical outcomes were assessed. We used descriptive statistics to analyze the data.<br /> Results and limitations: All procedures were completed successfully without additional ports or conversions. The median console time and estimated blood loss were 107 min and 100 ml, respectively. Transfusion rate was 0%. Intraoperative complications included two suspected air emboli attributed to high insufflation pressures. There were no major postoperative complications. In total, 95.8% were discharged within the first 24 h, with a median length of stay and pain score of 5 h and 3/10, respectively. There was persistent improvement in the median International Prostate Symptom Score and flow rate after 1 yr. The median Sexual Score Inventory for Men score was 20 at 12 mo. Our study is limited by its retrospective nature and cohort size.<br /> Conclusions: SP TV RASP is a feasible alternative for the management of severe benign prostatic hyperplasia that promotes fast recovery and demonstrates 1-yr improvement in urinary function.