Single-Port Extraperitoneal Robot Assisted Radical Prostatectomy – Description of Technique

Objective: The novel single-port (SP) platform offers an alternative way to perform robot-assisted radical prostatectomy (RARP). The SP platform allows operating in small anatomical spaces. Using this benefit, we adopted the extraperitoneal approach to RARP. Herein, we aim to describe our technique to perform SP extraperitoneal RARP.Patients and Surgical Procedure: We demonstrate the video of a 55-year-old man with a PSA of 4.4 ng/ml. Biopsy showed 5/13 cores positive for Gleason 3+3 prostate cancer. Preoperative prostate MRI showed a 43 g prostate and a right to midline anterior 1.8 cm PI-RADS 5 lesion, with possible extracapsular extension. We performed an extraperitoneal SP RARP and bilateral pelvic lymph node dissection.Results: The case was completed in 3 hours and 11 minutes. Estimated blood loss was 100 ml. Patient was discharged 8 hours after surgery. Pathology revealed pT2N0 stage and Gleason 3+4 prostate cancer. At 3 months follow up, PSA was undetectable and patient was continent. We performed 212 cases using this approach. Surgery was successfully completed in all patients without any need for additional port placement. Median length of stay was 4 hours, and 62 patients were admitted for observation. 50.5% of patients did not require opioid analgesics after discharge. Among patients with available one year follow data, 92.2% were continent and 85.9% had undetectable PSA.Conclusion: Extraperitoneal SP RARP can be safely performed using the novel SP surgical platform.