Comparing the Approach to Radical Prostatectomy Using the Multiport da Vinci Xi and da Vinci SP Robots: A Propensity Score Analysis of Perioperative Outcomes

Impact of transperitoneal anterior, retzius-sparing, extraperitoneal, transvesical and perineal approaches on urinary continence recovery after robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies

BACKGROUND

Urinary incontinence significantly impacts on health-related quality of life of patients undergoing radical prostatectomy. In the last decades, several approaches (extraperitoneal, Retzius-sparing (RS), perineal and, transvesical) for robot-assisted radical prostatectomy (RARP) have proposed with the aim to improve functional outcomes in comparison with transperitoneal, anterior ones.

METHODS

We performed a systematic review and meta-analysis of studies published in English language, in the last ten years, comparing the different approaches used to perform RARP. We included only studies reporting urinary continence rates at different follow-up time points. From each eligible study, we extracted the number of analyzed patients; the study design; the continence definition; and, when available, immediate, 1-, 3-, 6-, and 12-mo urinary continence rates. Statistical analyses were performed using RevMan version 5.4 (Cochrane Collaboration, Oxford, United Kingdom, UK). The Odds Ratio (OR) with 95% confidence intervals (CIs) was calculated using the generic inverse variance. A p value of <0.05 was set as significance level when comparing studies.

RESULTS

The meta-analyses of studies comparing anterior, transperitoneal RARP and RS-RARP in terms of immediate (OR = 3.73; 95% CI: 2.17-6.43; p < 0.0001), 1-mo (OR = 4.16; 95% CI: 2.68-6.48; p < 0.00001), 3-mo (OR 4.71; 95% CI: 3.70-6.00; p < 0.0001), 6-mo (OR 4.12; 95% CI: 2.95-5.75; p < 0.00001) and 12-mo (OR = 3.25; 95% CI: 1.76-5.99; p < 0.00001) urinary continence rates showed a statistically significant advantage in favor of RS approach. However, a sub-analysis of Randomized Controlled Trials showed overlapping urinary continence rates between the two approaches at 6-mo (OR = 1.99; 95% CI: 0.90-4.42; p = 0.09) and 12-mo (OR = 1.36; 95% CI: 0.43-4.31; p = 0.60) after surgery. The meta-analysis of studies comparing extraperitoneal and transperitoneal approaches showed that 6-mo urinary continence rates were overlapping between the two approaches (OR = 1.18; 95% CI: 0.85-1.65; p = 0.32). The meta-analysis of studies comparing single-port (SP) and multi-port (MP) RARP showed comparable 6-mo urinary continence rates (OR = 0.93; 95% CI 0.65-1.33; p = 0.69).

CONCLUSIONS

Within the limitations of mainly low to moderate quality of evidence, the RS  approach offers significant advantages compared to an anterior, transperitoneal, approach in terms of urinary continence recovery at different follow-up time points in patients who underwent MP-RARP. MP perineal and transvesical approaches need to be further tested and might be of interest in the setting of SP-RARP. Our meta-analysis showed comparable results between SP- and MP-RARP in terms of urinary continence rates.

Single-port robotic system - a paradigm shift in robot-assisted radical prostatectomy?

INTRODUCTION

Robotic-assisted radical prostatectomy (RARP) has become a cornerstone in the surgical management of prostate cancer. This study evaluates the potential of the Da Vinci single-port (SP) system, which represents a significant advancement in minimally invasive surgery.

AREAS COVERED

A narrative review was conducted using PubMed and Scopus databases to identify relevant studies published between January 2018 and February 2025. Search terms included 'single-port robotic prostatectomy,' 'Da Vinci SP system,' and 'robot-assisted radical prostatectomy.' Studies comparing SP and multi-port (MP) systems were prioritized. The SP system is discussed in terms of its technical innovations, including 360° operative field visualization, integrated optics and instruments, and enhanced depth perception. Clinical benefits, such as reduced blood loss, faster recovery, improved cosmetic outcomes, and reduced surgical trauma, are highlighted. Comparisons are drawn between the SP and multi-port systems, focusing on oncological and functional outcomes, as well as the challenges associated with the SP system's steeper learning curve.

EXPERT OPINION

The SP system holds great promise in advancing patient care in RARP, particularly through its minimally invasive approach. While achieving comparable outcomes to MP systems, it uniquely reduces surgical trauma. However, successful implementation requires overcoming technical challenges and adapting to the learning curve. Future research should focus on refining the technology and exploring its long-term impact on clinical outcomes.

Single-Port vs Multiport Robotic Surgery in Urologic Oncology: A Narrative Review

Introduction: Robotic surgery has improved the oncologic and functional outcomes of many urologic oncology procedures by optimizing visualization and instrument maneuverability. Since its FDA approval in 2018, the daVinci single-port (SP) platform has become increasingly utilized in urologic oncology, with its theoretical advantages over the standard multiport (MP) platform including improved cosmesis, reduced pain, and shorter hospitalization. Given this platform's relative novelty, comparisons between SP and MP robotic surgeries in urologic oncology tend to be small, non-randomized studies performed at centers of excellence. We review the existing literature comparing oncologic and functional outcomes between SP and MP surgeries to treat prostate, kidney, and bladder cancer. Methods: A literature review was performed in PubMed for studies comparing SP and MP prostatectomies, nephrectomies, and cystectomies from 2018 to 2024. The search was limited to English studies. Studies evaluating prostatectomy, nephrectomy, and cystectomy for nononcologic indications were excluded. Results: No difference in margin status or recurrence was definitively demonstrated between SP and MP radical prostatectomy, partial nephrectomy, or radical cystectomy. No clear difference in operative time, blood loss, or complication rates between SP and MP surgery was found. SP surgery may improve length of stay, pain, and satisfaction with incisions compared with MP surgery, though these differences were not robustly demonstrated across all studies. Key functional outcomes, such as change in kidney function in partial nephrectomy, and erectile/urinary function in radical prostatectomy, were similar between the SP and MP platforms. Conclusion: Based on current evidence from experienced surgeons at centers of excellence, the daVinci SP platform allows urologists to perform common oncologic procedures safely and effectively. Currently, no data definitively establishes improved oncologic or functional outcomes for SP surgery over MP surgery, though improved hospital stay and cosmesis are identified as theoretical benefits of an SP procedure.

Dual robotic surgery: Da Vinci SP® and Levita® MARS (magnetic-assisted robotic surgery) platforms

The applications of robotics in urology has been rapidly expanding since the introduction of the Da Vinci robotic platform in 2000. In recent years, there have been further developments in the robotic surgery space including advancements in Da Vinci's own robotic platform, the introduction of a single-port (SP®) system, as well as new competitors and adjacent technology that has come to the market. One such technology is the magnetic-assisted robotic surgery (MARS™) from Levita (Mountain View, CA). This system consists of a detachable magnetic grasper that can be placed within the body by a specialized laparoscopic instrument and manipulated from outside the body with an external magnet on a robotic arm that is surgeon controlled. Herein we describe the first dual robotic surgery employing MARS™ during an SP® transperitoneal robotic-assisted radical prostatectomy (RARP), demonstrating its feasibility and potential applications for use in single-port surgery in particular.

Robot-assisted Single-port Radical Prostatectomy with the SHURUI SP and da Vinci SP Platforms: Comparison of the Technology, Intraoperative Performance, and Outcomes

Background and objective

The purpose-built SHURUI single-port (SP) robotic platform has recently been introduced for several procedures in urology, general surgery, and gynecology. However, comparative evidence on its performance in relation to earlier models such as the da Vinci SP is lacking. Our aim was to compare the step-by-step techniques and 1-yr outcomes for radical prostatectomy (RP) between the SHURUI SP and da Vinci SP robots.

Methods

Data were retrieved from two prospectively maintained databases. The SHURUI SP robot was used to perform RP in 34 patients in China (September 2021 to August 2022); the da Vinci SP robot was used to perform 100 consecutive RP cases in the USA (June 2019 to October 2020). A comparative analysis was conducted before and after 1:1 propensity score matching for age, body mass index, American Urological Association symptom score, prostate size, prostate-specific antigen (PSA) levels, biopsy grade group, and D'Amico risk group. Intraoperative performance and short-term oncological and continence outcomes were compared between the groups. Biochemical recurrence was defined as two consecutive postoperative PSA levels >0.2 ng/ml. Continence was defined as full recovery of urinary control without the use of pads. The Kaplan-Meier method was used to estimate continence recovery curves, and a log-rank test for trend was used to detect ordered differences in continence recovery between the SHURUI SP and da Vinci SP groups after surgery.

Key findings and limitations

For the matched SHURUI and da Vinci groups, median age (69 vs 69 yr), median PSA (8.4 vs 7.1 ng/ml), and the proportion of patients with low-risk (33.3% vs 29.6%), intermediate-risk (66.7% vs 63%), and high-risk disease (0% vs 7.4%) were comparable (all p > 0.05). All surgeries were successfully accomplished without conversion. A higher percentage of cases in the SHURUI group involved extraperitoneal access (81.5% vs 0%; p < 0.001) and a pure SP approach (25.9% vs 0%; p = 0.01), while a higher percentage of cases in the da Vinci group had nerve-sparing surgery. The median total operative (215 vs 110 min; p < 0.001) and median console time (162 vs 75 min; p < 0.001) were significantly longer in the SHURUI group. No intraoperative or major postoperative complications were observed in either group. Rates of positive surgical margins (18.5% vs 14.8%; p = 1.0) and extraprostatic extension (14.8% vs 29.6%; p = 0.19) were similar. At median follow-up of 13.5 versus 15.9 mo, none of the patients had experienced biochemical recurrence. At 1 yr after surgery, the continence rate was 96.3% in both groups.

Conclusions

Despite differences in driving mechanisms between the two SP robotic systems, RP can be performed safely and effectively with the SHURUI RP robot during the initial learning phase, with similar short-term oncological and continence outcomes to those with the da Vinci SP robot.

Patient summary

We compared two surgical robots (SHURUI SP and da Vinci SP) used to perform robotic surgery to remove the prostate through a single keyhole incision instead of multiple incisions. Our results show comparable technology and similar surgical and short-term cancer control outcomes for the two robots.

Single-port robot-assisted pyeloplasty using the da Vinci SP system versus multi-port pyeloplasty: Comparison of outcomes and costs

OBJECTIVE

To investigate the feasibility of single-port (SP) robotic pyeloplasty by comparing perioperative outcomes with those of multiport (MP) robotic pyeloplasty.

MATERIALS AND METHODS

We reviewed the data from patients who underwent robot-assisted pyeloplasty for ureteropelvic junction obstruction (UPJO) at a single tertiary institution between March 2016 and May 2022. Radiographic and symptomatic improvements were assessed 3 months postoperatively. Propensity score matching was performed for age, sex, body mass index, and hydronephrosis grade.

RESULTS

Of the 15 S P-pyeloplasty and 28 MP-pyeloplasty cases, 14 from each group were matched using 1:1 matching. The SP group had shorter console and operative times without significant differences. Blood loss was lower in the SP group than in the MP group (p = 0.019). The length of hospital stay, opioid use on the operative day, and pain score at discharge did not differ between the two groups. The mean cost for surgery was higher in the SP group than in the MP group (p < 0.001). The mean cost of hospitalization was comparable between the two groups (p = 0.083). The cosmetic numerical rating scale scores were significantly higher in the SP group (p = 0.014). Symptoms improved in all patients, and the radiographic improvement rates were 92.9% in the SP group and 100% in the MP group.

CONCLUSION

SP-pyeloplasty showed cosmetic benefits, lower blood loss, operative time, and console time compared with MP-pyeloplasty. In patients who underwent surgery for UPJO for the first time, SP surgery can show comparable outcomes when compared to MP surgery.

Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy

Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.

Early outcomes of single-site versus multi-port robotic-assisted radical prostatectomy: A systematic review and meta-analysis

BACKGROUND

Single-site robotic-assisted radical prostatectomy (ssRARP) has been promoted in many institutions due to its minimally invasive approach. This review aimed to investigate early outcomes of ssRARP in comparison with multi-port robotic-assisted radical prostatectomy (mpRARP).

METHODS

A systematic literature search was performed for articles related to ssRARP case series and studies that compared ssRARP with mpRARP. The primary outcomes were functional and oncological outcomes, incision length, length of hospital stay and cost.

RESULTS

24 ssRARP case series involving 1385 cases, and 11 comparative studies involving 573 ssRARP cases and 980 mpRARP cases were included. Rate of immediate, 3-month, 6-month and 12-month recovery of continence in the ssRARP case series were 41 % [95 % CI: 0.38-0.45], 70 % [95 % CI: 0.67-0.73], 90 % [95 % CI: 0.87-0.93] and 93 % [95 % CI: 0.90-0.96]. 3-month potency recovery and positive surgical margin rate were 53 % [95 % CI: 0.46-0.60] and 21 % [95 % CI: 0.19-0.24]. No significant differences were detected between ssRARP and mpRARP in terms of 3-month (OR: 1.12; 95 % CI: 0.80-1.57) or 6-month (OR: 0.72; 95 % CI: 0.36-1.46) continence recovery rate, 3-month potency recovery rate (OR: 0.92; 95 % CI: 0.50-1.70), positive surgical margin rate (OR: 0.83; 95 % CI: 0.62-1.11), biochemical recurrence rate or total cost. Furthermore, ssRARP was associated with a significantly shorter length of incision and hospital stay.

CONCLUSION

ssRARP has significant advantages in cosmetic effect, length of incision and rapid recovery. Consequently, ssRARP is expected to become the preferred form although more evidence is needed to determine its long-term effect.

A prospective study on single-port versus multiport patient-reported surgical outcomes

Introduction

We sought to determine potential patient reported advantages of the da Vinci single-port (SP) robotic system for urological procedures compared with the previous model, the da Vinci multiport (MP) system. The SP model utilizes a single 30 to 40 mm incision rather than multiple 5 to 22 mm incisions. This project aims to prospectively investigate the impact of the novel SP system on patient reported cosmetic and psychometric surgical outcomes.

Methods

We conducted a prospective study of patients who underwent uro-oncologic surgery by three urologists at the University of Illinois Chicago from April to November 2021. Study participants completed a Patient Scar Assessment Questionnaire 20 and 90 days post-procedure. The Patient Scar Assessment Questionnaire is a reliable measure of surgical scars that includes five subscales: Appearance, Symptoms, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. Higher scores represented worse reported outcomes.

Results

On Postoperative Day 20, there were 77 responses (53 SP and 24 MP). Patients receiving SP procedures reported more favourable outcomes in terms of appearance, symptoms, consciousness, and pain medication. On Day 90, there were 37 responses (24 SP and 13 MP). Patients receiving SP procedures reported more favourable outcomes in terms of appearance. No significant differences were seen on Day 90 in terms of pain, medication, symptoms, consciousness, or satisfaction.

Conclusions

This study demonstrates the superiority of the SP in patient reported cosmetic and pain outcomes on short- and long-term follow-up after uro-oncological surgical procedures. Symptomatic and cosmetic advantages are present at the 20 day follow-up, with better scar appearance being significant 90 days after surgery.

Single-port and multiport robot-assisted radical prostatectomy: A meta-analysis

Objective

To compare the perioperative, oncological, and functional outcomes between single-port robot-assisted radical prostatectomy (SP-RARP) and multiport robot-assisted radical prostatectomy (MP-RARP) via a meta-analysis.

Methods

For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 15, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI).

Results

Of the 368 retrieved abstracts, 41 underwent full-text review, and seven studies were included in the final analysis, comprising a total cohort of 1,934 cases of RARP (355 SP-RARP cases and 1,579 MP-RARP cases). Compared to MP-RARP, the SP-RARP group had less postoperative pain score (MD = -0.7, 95% CI -1 to -0.4, P<0.001), morphine milligram equivalents usage (MD = -3.8, 95% CI -7.5 to -0.1, P=0.04), hospital stay (MD = -1, 95% CI -1.8 to -0.1, P=0.019), and urinary catheterization time (MD = -1.1, 95% CI -1.9 to -0.3, P=0.008). However, the SP-RARP group had a longer console time than the MP-RARP group (MD = 5.3, 95% CI 2.6 to 7.9, P<0.001).

Conclusions

Our study demonstrated that early results were mostly equivalent with the single-port approach. This technology may help to reduce the hospital stay and postoperative pain for patients undergoing radical prostatectomy compared to MP-RARP, without compromising the functional and early oncological outcomes.

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy: A single center analysis

Objective

In the last 10 years, robotic platforms allowed to resume of some alternative surgical approaches, including perineal robot-assisted radical prostatectomy (p-RARP). Herein, we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.

Methods

Patients presenting low- or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected. Baseline, intraoperative, pathological, and postoperative data were collected and then analyzed.

Results

Thirty-seven p-RARP cases were included. Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4. Body mass index of ≥25 kg/m2 was reported by 24 (64.9%) patients, as well as 7 (18.9%) patients reported a past surgical history. Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL, respectively. The median operative time was 242 min. The positive surgical margin rate was 45.9%. In terms of postoperative complications, 10 patients reported complications with any grade; however, a single case (2.7%) of major (Clavien-Dindo grade ≥3) complication was observed. No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up. Recovery of continence rates were 67.6%, 75.7%, and 92.9%, at 6 months, 12 months, and 24 months after surgery, respectively.

Conclusion

p-RARP is a challenging but safe minimally invasive approach for selected patients with prostate cancer suitable for radical prostatectomy, showing outstanding functional recovery. Despite positive surgical margin rates being relatively high, no cases of biochemical recurrence or distant metastasis were reported after a median follow-up of 30 months.

Single-Port Robot-Assisted Radical Prostatectomy with the Novel Shurui Single-Port Robotic Surgical System

Purpose: The aim of this study was to explore the safety and efficacy of radical prostatectomy with a novel Shurui single-port (SR-SP) robotic surgical system. Methods: A total of 11 patients with prostate cancer were enrolled in this study. Extraperitoneal radical prostatectomy was performed using the SR-SP robotic surgical system for all patients. Clinicopathologic data, perioperative data, and short-term surgical outcomes were prospectively collected and analyzed. Results: Of the 11 patients, the median age was 65 years (range 52-73), and the median body mass index was 22.6 kg/m2 (range 20.2-26.7). The median operative time was 229 minutes (range 194-317), and the median console time was 167 minutes (range 141-265). The median blood loss was 40 mL (range 10-120), and none of the patients required intraoperative transfusion. There was no conversion to open surgery during the operation, and no assistant ports were added. The surgeons reported a good task load rating with a National Aeronautics and Space Administration Task Load Index (NASA-TLX) score of 25.1 ± 3.3 points. The median postoperative hospital stay time was 7 days (range 4-15). There were no severe intraoperative or postoperative complications (Clavien grade ≥3). Postoperative positive surgical margin occurred in 4 (36.4%) patients. No biochemical recurrence occurred within 1 month of surgery. The continence rate was 72.7% (8/11) 1 month after surgery. Conclusions: The new SR-SP robotic surgical system is safe, effective, flexible, and stable for application in radical prostatectomy.

Perioperative results of single-port vs multi-port robotic-assisted radical prostatectomy via peritoneal approach: a meta-analysis

To compare the perioperative outcomes of single-port robotic-assisted radical prostatectomy (SP-RARP) and multiport robotic-assisted radical prostatectomy (MP-RARP) via transperitoneal approach, we conducted a comprehensive database search of eligible studies up to October 2022 and compared their results. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and a leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of six articles were included, involving 926 patients, among which 256 underwent SP-RARP and 670 underwent MP-RARP. Comparing the two, SP-RARP was associated with shorter hospitalization time (- 0.5 days; 95% CI - 1.02, - 0.06, p < 0.05) and less intraoperative blood loss (- 29.88 ml; 95% CI - 45.66, - 14.10, p < 0.05). However, there were no significant differences in any complications, operative time, positive surgical margins, or short-term follow-up outcomes (continence and potency at 3 months). These findings provide reference data for the selection of surgical methods in performing transperitoneal RP and support further research on the broad applicability of the SP platform.

Comparison between intra- and postoperative outcomes of the da Vinci SP and da Vinci Xi robotic platforms in patients undergoing radical prostatectomy

The new SP robot incorporates a single trocar that houses a flexible camera and three bi-articulated arms, which minimize the number of incisions needed to assess the surgical site, allowing for a less invasive procedure. To compare the postoperative pain scale and outcomes in patients with similar demographic characteristics undergoing robotic-assisted radical prostatectomy (RARP) with SP and Xi robots, One-hundred consecutive patients undergoing RARP with the SP robot were matched, using a propensity score (PS), with 100 patients from a cohort of 1757 who were operated on with the da Vinci Xi from June 2019 to January 2021. We described and compared the perioperative pain scores and outcomes of both groups. The SP group had less blood loss (50 cc vs. 62.5 cc, P < 0.001) and longer operative time (114 min. vs. 94 min, P < 0.001). The only period we could show a difference in postoperative pain scores was 6 h after surgery, with a small advantage for the SP (2 vs. 2.5, P < 0.001). Both groups had satisfactory postoperative continence recovery, 91% vs. 90% for the SP and Xi, respectively. The groups had a mean follow-up of 24.5 and 22 months for SP and Xi, respectively. The tumor stage and percentage of positive surgical margins were similar between groups (15% vs. 15%, P = 1). Patients undergoing RARP with the SP had longer operative times with less blood loss than the Xi. However, despite the lower number of abdominal incisions on the SP, the groups had similar intraoperative performance, and we were unable to demonstrate clinically significant differences in postoperative pain scores between the groups 6, 12, and 18 h after surgery.

Recent advances in single-site/incision robotic-assisted radical prostatectomy

INTRODUCTION

Single-site robotic-assisted radical prostatectomy (ssRARP) has been successfully applied to treat prostate cancer. This review aims to describe the recent advances of surgical approaches, working accesses and novel robotic platforms in ssRARP.

MATERIAL AND METHODS

A systematic literature search was performed by searching the PubMed, EMBASE, Web of Science and Scopus databases in December 2022 to identify all literature related to ssRARP.

RESULTS

A total of 48 relevant studies were found worldwide from 2008 to 2023. Since the introduction of ssRARP, various modifications of this technique in surgical approaches, working accesses and novel robotic platforms have been developed. The application of ssRARP using the da Vinci SP platform has shown great superiority with encouraging clinical outcomes.

DISCUSSION

There has been a potential shift toward ssRARP using the da Vinci SP platform due to its potential advantages in terms of lower blood loss, minimal postoperative pain, better cosmetic outcome and rapid recovery. More convincing evidence, further technical improvement and higher cost-effectiveness are needed for its widespread acceptance.

Single-Port Robotic Applications in Urology

Objective: The da Vinci single-port (SP) platform represents the latest innovation in minimally invasive urologic surgery, and the adoption of this technology by urologists is increasing. In this article, we briefly describe the evolution of minimally invasive and single-site surgery, and offer a comprehensive review of the current literature on the SP platform. Materials and Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until August 15, 2022. The published literature to date within SP robotic surgery in urology will be discussed. Evidence Synthesis: There are relatively few high-quality studies on the SP system, but there are multiple case series describing unique indications and surgical approaches with the SP robot, demonstrating safety and feasibility in the hands of experienced robotic surgeons. There also are an increasing number of prospective, larger cohort studies comparing outcomes between SP and multiport (MP) approaches that show benefits of the SP system regarding improved cosmesis, postoperative pain control, and decreased length of stay. Conclusions: Multiple prospective studies have shown benefits regarding cost and pain control for SP platform procedures compared to the traditional MP robotic approach. While its high cost and learning curve represent barriers to adoption, the SP platform represents a critical development in minimally invasive surgery. As this technology is further implemented at more institutions, long-term, high-quality data should accrue that will demonstrate its true value.

Preliminary comparison of the modified extraperitoneal free-PORT single incision technique and transabdominal multi-incision robot-assisted laparoscopic radical prostatectomy

To compare the clinical efficacy of an innovative modified single-incision technique without special extraperitoneal PORT with that of transperitoneal multi-incision robot-assisted laparoscopic radical prostatectomy and to explore the feasibility and safety of the former. A retrospective analysis was performed on 259 patients who received robot-assisted laparoscopic radical prostatectomy in the Robot Minimally Invasive Center of Sichuan Provincial People's Hospital between September 2018 and August 2021. Among them were 147 cases involving extraperitoneal single incision with no special PORT (Group A) and 112 cases involving multiple incisions by the transperitoneal method (Group B). Differences in age, PSA level, Gleason score, prostate volume, body mass index, clinical stage, lower abdominal operation history, and lymph node dissection ratio between the two groups were not statistically significant (P > 0.05). All operations were performed by the same operator. In this study, all 259 operations were completed successfully, and there was no conversion. There was no significant difference in transperitoneal blood loss, postoperative hospital stay, positive rate of incision margin, indwelling time of urinary catheter, satisfaction rate of immediate urine control, satisfaction rate of urine control 3 months after operation, positive rate of postoperative lymph node pathology or postoperative pathological stage between the two groups (P > 0.05). There were significant differences in operation time, postoperative exhaust time and incision length (P < 0.05). The modified extraperitoneal nonspecial PORT single-incision technique is safe and feasible for robot-assisted laparoscopic radical prostatectomy, and its curative effect is similar to that of transperitoneal multi-incision RARP. It has the advantages of a short operation time, less impact on the gastrointestinal tract and a more beautiful incision. The long-term effect of treatment needs to be further confirmed by prospective studies.

Intraoperative Ergonomic Assessment of Exoscopes versus Conventional DIEP Flap

BACKGROUND

 This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics.

METHODS

 Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected.

RESULTS

 The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the "surgeon at abdomen" showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the "surgeon at chest" showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference.

CONCLUSION

 Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

Intraoperative workload during robotic radical prostatectomy: Comparison between multi-port da Vinci Xi and single port da Vinci SP robots

The goal of this study was to quantify and compare prospective self-reported intraoperative workload and teamwork during robot-assisted radical prostatectomy (RARP) for multi-port da Vinci Xi (MP) and single-port da Vinci SP (SP) robots. The self-reported workload (surgeon and surgical team) and teamwork (surgeon) measures were collected and compared between MP and SP RARPs, as well as the learning curve. Results from 25 MP and SP RARPs showed that overall, the NASA-TLX workload subscales were lower, and the teamwork modified NOTECHS subscales were higher for the MP RARPs compared to the SP RARPs. The underlying reason for the significant differences between these two RARP surgical procedures could be other factors (e.g., robot design factors) in addition to the surgeon and surgical team's experience. The results also suggested learning effects through the 25 SP RARPs; however, twenty-five procedures may not be enough to achieve proficiency with the SP system.

Can a single-port robot be safely used for robotic total gastrectomy for advanced gastric cancer? First experience using the da Vinci SP platform

Background

Many studies have shown the operative feasibility and safety of robotic gastrectomy. Surgeons are pursuing single-port (SP) surgery to leverage the advantages of minimally invasive gastrectomy. The purpose of this study was to describe technical considerations and short-term outcomes from the first reported SP robotic total gastrectomy (RTG) using the da Vinci SP platform.

Methods

A 75-year-old patient with a body-mass index of 19.8 kg/m² and clinical stage III cancer (cT3N+M0) underwent SP RTG on 22 January 2022 at the Department of General Surgery, the Chinese PLA General Hospital. All procedures were performed successfully using the da Vinci SP robotic platform.

Results

The SP RTG was successfully performed with D2 lymphadenectomy including No. 10 lymph-nodes dissection and extracorporeal Roux-en-Y anastomosis. Except for subcutaneous emphysema, no severe adverse events occurred during the operation. According to a visual analogue scale (VAS), the subjective feeling of post-operative pain was given a VAS score of 3 of 10 on Post-Operative Day 1 (POD 1), 1 of 10 on POD 3, and 1 of 10 on POD 7. We removed the gastric tube on POD 2 and advised sipping water, a liquid diet, and a soft diet on PODs 2, 4, and 6, respectively. The patient was discharged without any complications on POD 8.

Conclusion

RTG is technically feasible and safe using the da Vinci SP robotic platform. To our knowledge, this is the first study using the da Vinci SP platform in RTG for advanced gastric cancer in elderly patients. To verify its superior operative outcomes, further clinical trials are needed.

Single-port versus multiport robotic-assisted radical prostatectomy: A systematic review and meta-analysis on the da Vinci SP platform

CONTEXT

Prostate cancer is the most common cancer in men; robotic prostatectomy has cemented itself as part of the standard of care. Since its approval by the Food and Drug Administration in 2018, the SP console's application has been increasingly studied and compared with the multiport (MP) robotic approach.

METHODS

Following PRISMA guidelines and PROSPERO registration CRD42021228744, a systematic review was performed in April 2021 on single-port robotic-assisted radical prostatectomies (SP-RARPs) compared to MP. Outcomes of interest were operative time, bleeding, complications, analgesic use, and postoperative continence, and erectile function. Data were analyzed with Review Manager 5.3.

RESULTS

Seven studies were included, of which six studies met the inclusion criteria for quantitative synthesis, totalling 1068 patients, out of which 324 underwent SP-RARP and 744 underwent MP-RARP. No differences were found in baseline characteristics such as age, body mass index, prostatic-specific antigen, or stage. No differences in blood loss-15.77 mL [-42.44, 10.89], p = 0.25, operative time 3.93 min [-4.12, 11.98], p = 0.34, or positive surgical margins, with an odds ratio (OR) of 0.78 [0.55, 1.10], p = 0.15-were found. Length of stay was significantly shorter in SP -0.94 days [-1.56, -0.33], p = 0.003, with no differences in complication rates, with an OR of 1.29 [0.78, 2.14], p = 0.32, continence rates, with an OR of 1.29 [0.90, 1.83], p = 0.16, erectile function, with an OR of 0.86 [0.52, 1.40], p = 0.54, or biochemical recurrence. Qualitative evidence suggests decreased opioid consumption.

CONCLUSION

SP-RARPs are feasible alternatives to the traditional MP with possible benefits in pain management and length of stay. Future high-quality studies are needed to confirm these findings.

Same Day Discharge Protocol for Robotic Assisted Radical Prostatectomy: the experience of a High-Volume Referral Center

Objective As the COVID-19 global pandemic continues, there is increased value in performing same-day discharge (SDD) protocols to minimize viral exposure and maintain the appropriate surgical treatment for oncological patients. In this scenario, we performed a prospective analysis of outcomes of our patients undergoing SDD protocol after robotic-assisted radical prostatectomy (RARP). Material and Methods The SDD criteria included patients with no intraoperative complications, stable postoperative hemoglobin levels (compared to preoperative values), stable vital signs, normal urine output, ambulation with assistance and independently without dizziness, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family confidence with SDD. Patients older than 70 years, concomitant general surgery operations, multiple comorbidities, and complex procedures such as salvage surgery were excluded from our protocol. Results Of the 101 patients who met the criteria for SDD, 73 (72%) had a successful SDD. All SDF (Same day discharge failure) patients were discharged one day after surgery. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) vs 103 (91-111) minutes for SDD and SDF respectively. Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%), drowsiness (7%), patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). There was no significant difference in readmission rates, complication rates, or post-operative pain scores between SDD and SDF patients. Conclusions In our experience, SDD for patients undergoing RARP can be safely and feasibly incorporated into a clinical care pathway without increasing readmission rates. We were successful in 72% of cases due to coordinated care between anesthetics, nursing staff, and appropriate patient selection. We also believe that incorporating pre-and postoperative patient education and assurance is crucial to minimize their exposure to COVID-19 during the surgical treatment for prostate cancer.

Does type of robotic platform make a difference in the final cost of robotic-assisted radical prostatectomy?

This study evaluates the difference of robot-assisted radical prostatectomy (RARP) costs in patients with similar preoperative characteristics operated on using the da Vinci^® SP and Xi robotic platforms. We performed a retrospective analysis on 71 consecutive patients with prostate cancer who underwent RARP with the SP robot between June 2019 and April 2020. Propensity score (PS) matching was performed and 71 patients were selected from a cohort of 875 who underwent RARP with the Xi robot in the same period. We divided the total expense per surgery into the cost of disposable materials, robotic instruments (initial purchasing cost divided by the number of "lives"), and operative room costs. Only variable costs are included in this study, as fixed costs do not vary between procedures and are the same for both cohorts. Fixed costs include anesthesia, pathology, surgeon, and hospitalization fees. The median total cost for SP-RARP was $5586 ($5360-$5982) USD and $4875 ($4661-$5093) USD with the XI for a median cost difference of $707 ($584-$832) (P < 0.001). The median cost of disposables for the SP was $1877 ($1588-$2193) USD and for the Xi $1527 ($1407-$1781) USD, P < 0.001. Non-disposable instruments cost per case (fixed cost) was $1610 and $1270 USD for the SP and Xi, respectively. The cost of radical prostatectomy in the SP cohort is higher than the Xi cohort. The greater price was primarily due to the increased cost of instruments and disposable materials. In our experience, the lack of GelPOINT and space maker is also crucial factors to decrease the SP total cost.

Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis

Background

The purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy.

Methods

Using the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data.

Results

A total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I²=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I²=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I²=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I²=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited.

Discussion

Our results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.

Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis

Background: Single-port robotic-assisted radical prostatectomy has been reported as a safe and feasible technique. However, recent studies comparing single-port versus multiple-port robotic radical prostatectomy have displayed conflicting results. Objectives: To investigate the benefit of single-port robotic radical prostatectomy and the impact on outcome compared to multiple-port robotic radical prostatectomy. Methods: Based on PRISMA and AMSTAR criteria, a systematic review and meta-analysis were carried out. Finally, we considered the controlled studies with two cohorts (one cohort for single-port RARP and the other cohort for multiple-port RARP). For statistical analysis, Review Manager (RevMan) software version 5.4 was used. The Newcastle-Ottawa Scale was employed to assess the risk of bias. Results: Five non-randomized controlled studies with 666 patients were included. Single-port robotic radical prostatectomy was associated with shorter hospital stays. Only 60.6% of single-port patients (109/180) required analgesia compared to 90% (224/249) of multiple-port patients (Z = 3.50; p = 0.0005; 95% CI 0.07:0.47). Opioid administration was also significantly lower in single-port patients, 26.2% (34/130) vs. 56.6% (77/136) (Z = 4.90; p < 0.00001; 95% CI 0.15:–0.44) There was no significant difference in operative time, blood loss, complication rate, positive surgical margin rate, or continence at day 90. Conclusion: The available data on single-port robotic radical prostatectomy is very limited. However, it seems comparable to the multiple-port platform in terms of short-term outcomes when performed with expert surgeons. Single-port prostatectomies might provide a shorter hospital stay and a lower requirement for opioids; however, randomized trials with long-term follow-up are mandatory for valid comparisons.

Single-Port versus Multi-Port Robot-Assisted Radical Prostatectomy: A Propensity Score Matching Comparative Study

PURPOSE

To compare the perioperative outcomes of patients who underwent single-port (SP) robot-assisted radical prostatectomy (RARP) and those who underwent multi-port (MP)-RARP.

METHODS

Data on 40 consecutive patients who underwent SP-RARP between June 2020 and February 2021 and 129 who underwent MP-RARP between June 2019 and February 2021 were retrospectively reviewed. Using logistic regression, 31 patients who underwent SP-RARP were matched to 31 patients who underwent MP-RARP (1:1) based on propensity scores. The available perioperative parameters and outcomes were analyzed.

RESULTS

Compared to MP-RARP, SP-RARP showed no significant differences in perioperative parameters, including the console times (111.0±15.7 vs. 102.6±18.8 minutes, p=0.569), operation time (151.3±15.1 vs. 158.7±20.3 minutes, p=0.863), estimated blood loss (121.1±64.7 vs. 140.5±90.5 mL, p=0.638), positive surgical margins (19.4% in both groups), and 3-month continence (77.4% vs. 83.9%, p=0.563) and potency (45.2% vs. 48.4%, p=0.891) rates. Patients who underwent SP-RARP had lower proportions of complete nerve sparing than those who underwent MP-RARP (SP-RARP vs. MP-RARP in subjective scores: 4.0±0.8 vs. 4.4±0.9, p=0.046; SP-RARP vs. MP-RARP in pathologic score of 5, 35.5% vs. 64.5%, p=0.049; score of 4, 41.9% vs. 19.4%, p=0.038; score of 3, 19.4% vs. 9.7%, p=0.398; score of 2, 3.2% vs. 0.0%, p=0.365; and score of 1, 3.2% vs. 3.2%, p=0.932, respectively).

CONCLUSIONS

SP-RARP showed lower nerve sparing scores than MP-RARP, the present study suggests that SP-RARP is safe and feasible with comparable short-term functional outcomes as those of MP-RARP.

Neurovascular bundle preservation in robotic-assisted radical prostatectomy: How I do it after 15.000 cases

Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Future Platforms of Robotic Surgery

Among the various robotic devices that exist for urologic surgery, the most common are synergistic telemanipulator systems. Several have achieved clinical feasibility and have been licensed for use in humans: the standard da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius, and Surgenius. Handheld and hands-on synergistic systems are also clinically relevant for use in urologic surgeries, including minimally invasive and endoscopic approaches. Future trends of robotic innovation include an exploration of more robust haptic systems that offer kinesthetic and tactile feedback; miniaturization and microrobotics; enhanced visual feedback with greater magnification and higher fidelity detail; and autonomous robots.

Robot-Assisted Radical Prostatectomy Maneuvers to Attenuate Erectile Dysfunction: Technical Description and Video Compilation

Erectile dysfunction (ED) remains a significant problem in up to 63% of men after robot-assisted radical prostatectomy (RARP). After the discovery of the neurovascular bundle (NVB), additional anatomic description and variation in nerve-sparing (NS) techniques have been described to improve post-RARP ED. However, it remains questionable whether ED rates have improved over time, and this is concerning as competing treatments are introduced that have better ED outcomes. In this review, we describe RARP NS technical modifications that improve erectile function recovery. We focused on reports that included detailed anatomical descriptions as well as video illustrations to disseminate technique. We found that the alternative RARP NS surgical techniques provide better outcomes compared with standard NS RARP. The use of validated quality of life questionnaires is necessary for the appropriate comparison of outcomes. However, the retrospective character and inherent weaknesses of the included studies do not allow one to conclude which is the best NS approach. Overall, there is significant variation in RARP NS techniques and outcomes, and the ideal technical maneuvers to optimize outcomes remains subject to debate. However, there is a consensus on the importance of anatomically dissecting the NVB, minimizing traction and thermal injury as well as preserving the periprostatic fascia. Well-designed randomized controlled trials with videos describing details of different surgical techniques for generalizability are needed to consistently and objectively evaluate sexual function outcomes after RARP to optimize postoperative potency.

A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system

BACKGROUND

Single-incision robotic cholecystectomy (SIRC) is widely performed with both the da Vinci Xi system (Xi) and the da Vinci SP system (SP). But there are limited numbers of studies comparing these platforms.

METHODS

Patients who underwent SIRC between 2019 and 2020 were enrolled. Patient demographics, intraoperative factors, postoperative complications, postoperative pain were compared using a one-to-one propensity score matching (PSM).

RESULTS

Overall, 258 patients underwent SIRC with Xi and 72 with SP. After PSM, there were significant differences between the Xi and SP in operation time at console and numeric rating scale for postoperative pain, but no difference in total operation time and postoperative complications. The SP group showed more estimated blood loss.

CONCLUSIONS

Despite the statistical difference, clinical benefit was not significant. Both platforms can be safe and feasible to perform SIRC, but further investigation including the surgeon's workload and ergonomics is needed as a prospective study.

Da Vinci Single-Port Robotic Radical Prostatectomy

The field of robotic surgery continues to evolve and the advent of the single-port (SP) platform is another step toward the future. The SP platform is a new technology that has promising implications for urologic surgery. Since the Food and Drug Administration (FDA) cleared this platform in 2018, multiple urologic procedures have been described, with radical prostatectomy being the most common. This article aims to describe and illustrate the step-by-step technique of SP radical prostatectomy. We have described our technique from the patient positioning and trocar placement until the anastomosis. We included in the video compilation surgical steps such as bladder dropping and anterior bladder neck dissection, posterior bladder neck and seminal vesicles, posterior prostate dissection and nerve sparing, apical dissection and dorsal venous complex control, posterior reconstruction and anastomosis, and lymph node dissection.

Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis

Purpose: Although single-port robot-assisted radical prostatectomy (SP-RARP) is considered a safe and feasible approach for radical prostatectomy, the comparative performance of the SP robot with earlier models, including da Vinci Xi or Si, is elusive. This systematic review summarizes the current evidence on SP-RARP and compares its perioperative, functional, and oncologic outcomes to multiport robot-assisted radical prostatectomy (MP-RARP). Methods: We performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare SP-RARP to MP-RARP. The primary outcomes included perioperative, functional, oncologic, and painful outcomes. The odds ratio (OR) and weighted mean difference (WMD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Results: Seven studies, including 1239 patients, were enrolled in the meta-analysis. We reported similar results for SP-RARP and MP-RARP in terms of the operative time, blood loss, continence and potency rates, complication rate, positive surgical margin, and biochemical recurrence. However, hospital stay (WMD -17.86 hours, 95% CI -27.80 to -7.92; p = 0.0004), catheterization time (WMD -1.51 days, 95% CI -2.60 to -0.41; p = 0.007), and the rate of opioid use (OR 0.26, 95% CI 0.13 to 0.53; p = 0.0002) were less with SP-RARP. In addition, more patients did not require any pain medication during the hospital stay with SP-RARP (OR 14.41, 95% CI 5.22 to 39.76; p < 0.00001). Conclusions: SP-RARP is associated with a shorter hospital stay and catheterization time, and the need for postoperative pain medication is lower compared to MP-RARP, with comparable perioperative, functional, and oncologic outcomes.

Patient surgical satisfaction after da Vinci® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis

The da Vinci^® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% (n = 61) in the Xi group and 73.2% (n = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference (P < 0.001) in terms of number of scars that favors the SP approach. Limitations of this study are the small sample size and recall bias. We found no statistical difference between the groups regarding the answers for SSQ-8 questionnaire; both groups were very satisfied. When assessing the number of incision sites with the GRI-1 question, patients who underwent MP had lower satisfaction rates compared to SP. These patients perceived the number of scars and their appearance as reason for lower satisfaction. We believe that future studies should consider patient’s postoperative perspective when adopting new platforms in order to combine adequate treatment with patient expectations. We performed a study assessing the postoperative satisfaction and perspectives of two groups of patients who underwent radical prostatectomy with two different robots (SP and Xi). There was no difference in patient satisfaction with the results of either the da Vinci^® SP or Xi RARP except for the patients’ perception on their number of scars, which favored the SP group.

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port-a single surgeon pathway

To describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.

Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases

Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes.