Technical advancements in robotic prostatectomy: single-port extraperitoneal robotic-assisted radical prostatectomy and single-port transperineal robotic-assisted radical prostatectomy

Alireza Aminsharifi, Guilherme Sawczyn, Clark A. Wilson, Juan Garisto, Jihad Kaouk


Background: To describe our step-by-step techniques for single-port robotic-assisted extraperitoneal and perineal radical prostatectomy as recent technical advancements in this field.
Methods: An English-language literature review was done using search terms including extraperitoneal, transperineal, single-port, robotic surgery, prostate cancer, radical prostatectomy in various combinations. Unique features of the da Vinci SP® platform are discussed. Details of surgical techniques with single-port robotic platform are also covered.
Results: The relatively recent introduction of the da Vinci SP platform has led to the development of novel techniques for radical prostatectomy. Unique features of this platform including intracorporeal triangulation and double-articulating instruments will likely lead to widespread applications of this novel system. The principles of radical prostatectomy are reproducible with both extraperitoneal and perineal approaches via a single incision.
Conclusions: A better cosmetic results as well as a quick recovery maybe potential advantages of single- port extraperitoneal/transperineal robotic prostatectomy. By avoiding the peritoneal cavity, a lower rate of bowel related complications and minimum systemic CO2 absorption can be expected. Adverse effects of steep Trendelenburg positioning can be avoided with these techniques. Evaluation of the oncological and functional outcomes of these techniques will be necessary. Comparative trials with standard robotic surgery and cost-analysis studies remain hot topics for research after implementation of these new platforms at any institute.