Comparing outcomes in single-port versus multiport robotic radical prostate surgery

This study compared the surgical outcomes of patients undergoing single-port extraperitoneal prostatectomy (SP-EPP) with conventional multiport transperitoneal robot-assisted radical prostatectomy (MP-RARP). The data showed that the SP-EPP approach was associated with a shorter length of hospital stay as well as a reduction in pain medication and opioid use after surgery in comparison with the conventional MP-RARP approach.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. It can be treated by surgery, radiation, or hormone therapy.

Robotic-assisted radical prostatectomy (RARP) is a type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo this surgery commonly have less blood loss and shorter hospital stays.

Most prostate cancer surgeries are done using a multiport (MP) robotic approach. MP-RARP involves four ports, each almost 1 cm long. Single-port extraperitoneal prostatectomy (SP-EPP) is a surgery that removes the entire prostate through a single 1-inch incision in the abdomen. It has been shown to be safe and feasible in previous studies. However, there are very few studies comparing the surgical outcomes of patients undergoing SP-EPP versus conventional MP-RARP.

This study involved 210 patients with PCa at a single institution. 100 patients underwent SP-EPP and 110 patients underwent MP-RARP.

The average estimated blood loss was significantly lower in the SP group (190ml) compared with the MP group (200ml).  67% of patients in the SP-group were discharged the same day compared with 7.3% of patients in the MP group. The average length of hospital stay after surgery was also significantly shorter in the SP group with 4.3 hours versus 26.1 hours in the MP group.

63.6% of patients in the MP group received opioids during their hospital stay compared with 32% of patients in the SP group. After getting discharged from the hospital, 87.3% of patients received opioid compared with 35% of patients in the SP group. 37% of the patients who underwent SP surgery did not require any pain medication during their hospital stay compared with 3.6% of patients in the MP group.

The continence rate (ability to control urine after surgery) after 12 months was similar between the 2 groups (85% with SP vs 88% with MP). 20% in the SP group and 25% in the MP group had preserved sexual function after 12 months.

This study concluded that the SP-EPP approach was associated with a shorter length of hospital stay as well as a decreased need for pain medication and opioid use after surgery in comparison with the conventional MP-RARP approach.

The study is looked back in time at medical records. It was also conducted at a single institution. This study included a limited number of participants and had a short follow-up time.