Propensity-matched Comparison of Single-port Transvesical Versus Standard Multiport Robotic Radical Prostatectomy

Abstract

Background and objective: Introduction of the purpose-built single-port (SP) robotic platform has paved the ways for the advent of novel, regionalized surgical techniques for robot-assisted radical prostatectomy (RARP), including the SP transvesical approach. This study sought to evaluate the perioperative, oncological, and functional outcomes of transvesical SP-RARP, in comparison with the standard multiport (MP) transperitoneal technique.

Methods: A retrospective review was performed on the institutional review board-approved, prospectively maintained database to identify all consecutive patients who underwent SP transvesical and MP transperitoneal RARP between 2015 and 2024. A 1:1 propensity-matched analysis was performed to ensure similar baseline clinicodemographic characteristics between the two groups, including prostate volume, preoperative prostate-specific antigen, International Society of Urological Pathology groups, and the clinical T stages.

Key findings and limitations: Of the 773 patients included in our series, our propensity score-matched analysis identified 285 cases in each of the SP transvesical and MP transperitoneal cohorts. All SP procedures were completed successfully without conversion or additional ports. Despite the similar preoperative characteristics and intraoperative outcomes, the SP group was associated with a more significant history of previous abdominal surgery, as defined by the Hostile Abdomen Index of 4 (SP 37.3% vs MP 4.3%, p < 0.001). In terms of the postoperative outcomes, the SP approach conferred increased rates of same-day discharges (SP 83.1% vs MP 1.1%, p < 0.001), reduced opioid prescriptions (SP 6.3% vs MP 89.4%, p < 0.001), and shorter postoperative Foley catheter duration (SP 4 d vs MP 7 d, p < 0.001). Furthermore, transvesical SP-RARP provided significant improvements in functional outcomes, with 47% achieving immediate continence, which subsequently grew to 82.8% at 3 mo and 91.7% at 6 mo. These rates were noticeably higher than the 70.5% (p = 0.008) and 89.7% (p = 0.642) continence rates at 3 and 6 mo, respectively, for the MP approach. Both groups were otherwise similar in terms of their sexual potency outcomes, particularly with satisfactory erectile function at 12 mo being reported in 85.7% and 82.1% of the SP and MP patients, respectively (p = 0.742). Limitations of this study included the retrospective, single-institution design, which may limit the generalizability of the findings.

Conclusions and clinical implications: Herein, we demonstrated the oncological safety and efficacy of the novel SP transvesical RARP, which remained comparable with the gold-standard MP transperitoneal approach. Albeit the need for further research and long-term follow-up data, the regionalized SP transvesical approach hold a strong promise toward further improvements in patient comfort and postoperative morbidity outcomes of RARP.

Keywords: Minimally invasive surgery; Radical prostatectomy; Robotic surgery; Single port; Transvesical.