Perioperative Outcomes of Single vs Multi-Port Robotic Assisted Radical Prostatectomy: A Single Institutional Experience

Purpose: Surgical approach to radical prostatectomy has evolved due to advances in minimally invasive surgery, with most contemporary approaches involving the Si or Xi multi-port robotic systems. U.S. Food and Drug Administration approval of the single-port da Vinci (R) SP robotic platform has led to a few case series suggesting its safety and feasibility for robotic assisted radical prostatectomy in patients with prostate cancer. However, there are no established data on perioperative outcomes comparing single-port to multi-port robotic approaches to robot-assisted radical prostatectomy. Materials and Methods: All patients who underwent robot-assisted radical prostatectomy by 2 urological surgeons at our institution between October 2018 and June 2019 were retrospectively reviewed. The available preoperative clinical and demographic data, operative parameters and postoperative outcomes were collected and analyzed using the t-test, chi-square and Fisher exact statistical measures. Results: Overall 95 patients who underwent robot-assisted radical prostatectomy at our institution were included in our study, with 47 single-port and 48 multi-port. Preoperative clinical parameters including age, body mass index, prior abdominal surgery and biopsy grade group were similar across the 2 groups. No differences in estimated blood loss (169.2 +/- 114.2 vs 157.7 +/- 125.4 ml, p=0.64), operative time (255.9 +/- 44.1 vs 274.7 +/- 50.4 minutes, p=0.06), length of hospitalization (1.1 +/- 0.5 vs 1.4 +/- 1.1 days, p=0.17), rate of perioperative inpatient Clavien-Dindo complications 2 or greater (4.3% vs 6.3% p=0.66) and rate of positive pathological margin (21.3% vs 27.1%, p=0.51) were noted comparing the single-port and multi-port approaches, respectively. Conclusions: The single-port robotic system allows a feasible approach to robot-assisted radical prostatectomy and has operative and perioperative outcomes comparable to those of the well accepted multi-port robotic approach.