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Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00787-2. [PMID: 38263281 DOI: 10.1038/s41391-024-00787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. METHODS A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. RESULTS A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. CONCLUSIONS Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Marco De Sio
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Jihad Kaouk
- Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Yu C, Xu L, Ye L, Zheng Q, Hu H, Ni K, Zhou C, Xue D, Cheng S, Wang H, Pak RW, Li G. Single-port robot-assisted perineal radical prostatectomy with the da Vinci XI system: initial experience and learning curve using the cumulative sum method. World J Surg Oncol 2023; 21:46. [PMID: 36782247 PMCID: PMC9926572 DOI: 10.1186/s12957-023-02927-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To evaluate the early functional and oncological outcomes of single-port robot-assisted perineal radical prostatectomy (sp-pRARP) using the da Vinci XI system and analyze its learning curve using the cumulative sum (CUSUM) method. METHODS The clinical data of 50 patients who underwent sp-pRARP for localized prostate cancer between May 2020 and May 2022 in our center by a single surgeon were analyzed retrospectively. Demographic information, preoperative and postoperative variables, complications, early functional and oncological outcomes of patients were recorded. The CUSUM method was used to illustrate the learning curve based on operation time. RESULTS All surgeries were completed without conversion. The median (interquartile range, IQR) operation time was 205.0 (82.5) min, whereas the median (IQR) docking time was 30.0 (15.0) min and the console time was 120.0 (80.5) min. The median (IQR) estimated blood loss (EBL) was 50.0 (137.5) mL. Positive surgical margins were detected in five patients (10.0%). The continence rate was 40.9%, 63.6%, 88.4%, and 97.7% at the 1, 3, 6, and 12 months after surgery. According to the CUSUM plot, the inflection points of the learning curve were 20 cases, splitting the case series into "early phase" and "late phase." In "late phase" cases, there was less time spent on each step of the operation and less EBL. CONCLUSIONS Sp-pRARP using the da Vinci XI system was verified to be a feasible and reliable surgical approach. According to the CUSUM plot, 20 cases was considered the turning point for surgeons to master the novel technique.
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Affiliation(s)
- Chenhao Yu
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Li Xu
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Liyin Ye
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Qiming Zheng
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Haiyi Hu
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Kangxin Ni
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Chenghao Zhou
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Dingwei Xue
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Sheng Cheng
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Hui Wang
- grid.415999.90000 0004 1798 9361Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016 Zhejiang China
| | - Raymond Wei Pak
- Department of Urology, Mayo Clinic-Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Minafra P, Carbonara U, Vitarelli A, Lucarelli G, Battaglia M, Ditonno P. Robotic radical perineal prostatectomy: tradition and evolution in the robotic era. Curr Opin Urol 2021; 31:11-17. [PMID: 33229862 DOI: 10.1097/mou.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms. RECENT FINDING The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients' morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer. SUMMARY Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
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Affiliation(s)
- Paolo Minafra
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, VCU Health, Richmond, Virginia, USA
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, National Cancer Institute IRCCS 'Giovanni Paolo II", Bari, Italy
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