Robotic Single-port Partial Prostatectomy for Anterior Tumors: Transvesical Approach.

OBJECTIVE: To evaluate the feasibility of a single-port transvesical robotic approach for anterior partial prostatectomy in a cadaver model.

MATERIALS AND METHODS: The cadavers were placed in a lithotomy position and secured to the operating table. A 3-cm midline incision was made in the suprapubic skin fold. After opening the Retzius space, a single-port mini device (GelPOINT, Rancho Margarita, CA) was introduced percutaneously directly into the bladder. The da Vinci Si robotic platform (Intuitive Surgical, Sunnyvale, CA) was docked to the GelPOINT by inserting 2 8-mm (robotic arms) and 1 12-mm (camera) trocar through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: (1) retrograde dissection of transition zone at the bladder neck, (2) lateral excision of the peripheral zone, and (3) urethrovesical anastomosis. Primary outcomes such as intraoperative complications, rate of conversion to standard techniques, and operative times were recorded.

RESULTS: Single-port transvesical robotic approach for anterior partial prostatectomy was technically completed in 2 male cadavers. Both cases were completed successfully using the da Vinci Si surgical system without conversion or the need for additional ports. There were no intraoperative complications. The total operative time was 124.1 and 81.3 minutes. Step-specific times are listed in Table 1.

CONCLUSION: Transvesical robotic partial prostatectomy is technically feasible using a single-port approach in a preclinical model. Further studies are needed for evaluation on patients with anterior localized prostate cancer. Prospective comparison with standard surgical techniques and focal therapy are warranted. Refinement of this technique may potentially expand the role of single-site surgery in the clinical practice.