Perioperative outcomes appear similar between patients with localized prostate cancer undergoing single-port versus multiport robot-assisted laparoscopic prostatectomy (RALP), researchers reported in European Urology. But significantly more patients treated via single-port access were pain-free on the first postoperative day and had shorter hospital stays.
Hari T. Vigneswaran, MD, of the University of Illinois at Chicago, and collaborators compared 50 patients treated with the single-port system (da Vinci SP) to 113 patients treated with the multi-port system (da Vinci Xi) from their institution.
Median operating room time did not differ significantly between the SP and MP groups for men undergoing prostatectomy alone (230 vs 240 min, respectively) or prostatectomy with bilateral pelvic lymphadenectomy (260 vs 280 min, respectively). Two-thirds of both groups had nerve-sparing surgery.
Significantly more SP patients were pain-free on day 1, according to self-reported pain scores: 30% vs 12%, respectively. Median morphine equivalents used, however, did not differ significantly between groups: 29% vs 28%, respectively.
Median hospital stay was significantly shorter for the SP group: 1 vs 2 days. However, postoperative complications graded higher than Clavien-Dindo 1 did not differ significantly between groups (14% vs 15%, respectively). Similar proportions experienced stress incontinence at 90 days (14% vs 13%, respectively).
Training on the next generation single-port system included a 1-day dry and wet course and 5 sessions (2 h each) of dry training the week before the first case.
“These findings show that the learning curve for SP-RALP is relatively short for an experienced robotic surgeon and may favor better pain control and shorter hospitalization,” Dr Vigneswaran’s team concluded.
Vigneswaran HT, Schwarzman LS, Francavilla S, et al. A Comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy [published online April 9, 2020]. Eur Urol. doi: 10.1016/j.eururo.2020.03.031