Extraperitoneal versus Transperitoneal Single-Port Robotic Radical Prostatectomy: A Comparative Analysis of Perioperative Outcomes.

To compare intraoperative and perioperative outcomes between extraperitoneal and transperitoneal radical prostatectomy performed by using a "purpose-designed" single-port robotic platform.

98 patients underwent single-port robotic prostatectomy using the da Vinci SP® robotic system with extraperitoneal (Group I (n=52)) versus transperitoneal (Group II (n=46)) approach. Demographics and perioperative data including postoperative recovery outcomes were recorded and compared between the two groups.

Groups were similar regarding demographics and prostate cancer risk category. Mean operative time (201± 37.5 min vs. 248.2 ± 42.3 min; p< 0.00001) as well as median postoperative hospital stay (4.3 vs. 25.7 hours p<0.0001) was significatly shorter with extraperitoneal approach. Overall need for pain medications or narcotics as well as the required amount of narcotics per patient (if administered) were significantly lower with the extraperitoneal approach. Extraprostatic extension was detected in 48.1% vs. 41.3% of patients in Groups I and II; respectively. Surgical margins were positive in 26.9% in Group I vs. 41.3% of patients Group II (p=0.13). More than 80% of patients with positive surgical margins had high risk features on final surgical pathology. 90-day continence rate was similar between the two groups (60% vs. 62.5%; p=0.82).

Extraperitoneal and transperitoneal single-port robotic radical prostatectomy are safe and feasible approaches. The extraperitoneal approach is associated with a significantly shorter postoperative hospital stay and decreased need for postoperative narcotics. Randomized trials with adequate sample size and postoperative follow up are advisable for further evaluation of the outcomes to clarify patient selection criteria for each approach.

The Journal of urology. 2019 Dec 17 [Epub ahead of print]

Jihad Kaouk, Alireza Aminsharifi, Clark A Wilson, Guilherme Sawczyn, Juan Garisto, Simone Francavilla, Michael Abern, Simone Crivellaro

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.