Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Patient Population
2.2. Statistical Analysis
3. Results
3.1. Perioperative Outcomes
3.2. Pathological/Oncological Outcomes
3.3. Functional Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Kaouk, J.; Bertolo, R.; Eltemamy, M.; Garisto, J. Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System. Urology 2019, 124, 309. [Google Scholar] [CrossRef] [PubMed]
- Kaouk, J.H.; Haber, G.P.; Autorino, R.; Crouzet, S.; Ouzzane, A.; Flamand, V.; Villers, A. A novel robotic system for single-port urologic surgery: First clinical investigation. Eur. Urol. 2014, 66, 1033–1043. [Google Scholar] [CrossRef] [PubMed]
- Lenfant, L.; Kim, S.; Aminsharifi, A.; Sawczyn, G.; Kaouk, J. Floating docking technique: A simple modification to improve the working space of the instruments during single-port robotic surgery. World J. Urol. 2021, 39, 1299–1305. [Google Scholar] [CrossRef] [PubMed]
- Soputro, N.A.; Kaouk, J. Single-port robot-assisted radical prostatectomy. World J. Urol. 2024, 42, 245. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Noël, J.; Moschovas, M.C.; Sandri, M.; Bhat, S.; Rogers, T.; Reddy, S.; Corder, C.; Patel, V. Patient surgical satisfaction after da Vinci® single-port and multi-port robotic-assisted radical prostatectomy: Propensity score-matched analysis. J. Robot. Surg. 2022, 16, 473–481. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Lenfant, L.; Garisto, J.; Sawczyn, G.; Wilson, C.A.; Aminsharifi, A.; Kim, S.; Schwen, Z.; Bertolo, R.; Kaouk, J. Robot-assisted Radical Prostatectomy Using Single-port Perineal Approach: Technique and Single-surgeon Matched-paired Comparative Outcomes. Eur. Urol. 2021, 79, 384–392. [Google Scholar] [CrossRef] [PubMed]
- Kaouk, J.; Valero, R.; Sawczyn, G.; Garisto, J. Extraperitoneal single-port robot-assisted radical prostatectomy: Initial experience and description of technique. BJU Int. 2020, 125, 182–189. [Google Scholar] [CrossRef] [PubMed]
- Kaouk, J.; Beksac, A.T.; Abou Zeinab, M.; Duncan, A.; Schwen, Z.R.; Eltemamy, M. Single Port Transvesical Robotic Radical Prostatectomy: Initial Clinical Experience and Description of Technique. Urology 2021, 155, 130–137. [Google Scholar] [CrossRef] [PubMed]
- Soputro, N.A.; Ferguson, E.L.; Ramos-Carpinteyro, R.; Chavali, J.S.; Kaouk, J. The Transition toward Opioid-sparing Outpatient Radical Prostatectomy: A Single Institution Experience with Three Contemporary Robotic Approaches. Urology 2023, 180, 140–150. [Google Scholar] [CrossRef] [PubMed]
- Wilson, C.A.; Aminsharifi, A.; Sawczyn, G.; Garisto, J.D.; Yau, R.; Eltemamy, M.; Kim, S.; Lenfant, L.; Kaouk, J. Outpatient Extraperitoneal Single-Port Robotic Radical Prostatectomy. Urology 2020, 144, 142–146. [Google Scholar] [CrossRef] [PubMed]
- Aminsharifi, A.; Wilson, C.A.; Sawczyn, G.; Kim, S.; Lenfant, L.; Kaouk, J. Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care. J. Endourol. 2020, 34, 1049–1054. [Google Scholar] [CrossRef] [PubMed]
- Ferguson, E.L.; Ramos-Carpinteyro, R.; Soputro, N.; Chavali, J.S.; Geskin, A.; Kaouk, J.H. Single-Port Robotic Radical Prostatectomy Using Transvesical and Transperineal Access in Patients with a Hostile Abdomen. J. Endourol. 2024, 38, 150–158. [Google Scholar] [CrossRef] [PubMed]
- Kaouk, J.; Ferguson, E.; Ramos-Carpinteyro, R.; Chavali, J.; Geskin, A.; Cummings, K.C.; Perilla, M. Transvesical Percutaneous Access Allows for Epidural Anesthesia without Mechanical Ventilation in Single-Port Robotic Radical and Simple Prostatectomy. Urology 2023, 175, 209–215. [Google Scholar] [CrossRef] [PubMed]
- Colombo, J.R., Jr.; Santos, B.; Hafron, J.; Gianduzzo, T.; Haber, G.P.; Kaouk, J.H. Robotic assisted radical prostatectomy: Surgical techniques and outcomes. Int. Braz. J. Urol. 2007, 33, 803–809. [Google Scholar] [CrossRef] [PubMed]
- National Comprehensive Cancer Network. Bone Cancer (Version 4.2024). Available online: https://www.nccn.org/login?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (accessed on 1 July 2024).
- Briganti, A.; Larcher, A.; Abdollah, F.; Capitanio, U.; Gallina, A.; Suardi, N.; Bianchi, M.; Sun, M.; Freschi, M.; Salonia, A.; et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur. Urol. 2012, 61, 480–487. [Google Scholar] [CrossRef] [PubMed]
- Ramos-Carpinteyro, R.; Ferguson, E.L.; Chavali, J.S.; Geskin, A.; Kaouk, J. First 100 cases of transvesical single-port robotic radical prostatectomy. Asian J. Urol. 2023, 10, 416–422. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Soputro, N.A.; Ferguson, E.L.; Ramos-Carpinteyro, R.; Chavali, J.S.; Geskin, A.; Kaouk, J. Vesicourethral Anastomosis in Transvesical Single-Port Robotic Radical Prostatectomy: A Technical Description and Perioperative Outcomes. J. Endourol. 2023, 37, 1001–1011. [Google Scholar] [CrossRef] [PubMed]
- Tewari, A.; Peabody, J.; Sarle, R.; Balakrishnan, G.; Hemal, A.; Shrivastava, A.; Menon, M. Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology 2002, 60, 569–572. [Google Scholar] [CrossRef] [PubMed]
- Rocco, B.; Coelho, R.F.; Albo, G.; Patel, V.R. Prostatectomia laparoscopica robot assistita: Tecnica chirurgica [Robot-assisted laparoscopic prostatectomy: Surgical technique]. Minerva Urol. Nefrol. 2010, 62, 295–304. (In Italian) [Google Scholar] [PubMed]
- Menon, M. Robotic radical retropubic prostatectomy. BJU Int. 2003, 91, 175–176. [Google Scholar] [CrossRef] [PubMed]
- Clavien, P.A.; Barkun, J.; De Oliveira, M.L.; Vauthey, J.N.; Dindo, D.; Schulick, R.D.; de Santibañes, E.; Pekolj, J.; Slankamenac, K.; Bassi, C.; et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann. Surg. 2009, 250, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Abou Zeinab, M.; Beksac, A.T.; Ferguson, E.; Kaviani, A.; Moschovas, M.C.; Joseph, J.; Kim, M.; Crivellaro, S.; Nix, J.; Patel, V.; et al. Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology 2023, 171, 140–145. [Google Scholar] [CrossRef] [PubMed]
- Ramos-Carpinteyro, R.; Ferguson, E.; Soputro, N.; Chavali, J.S.; Abou Zeinab, M.; Pedraza, A.; Mikesell, C.; Kaouk, J. Predictors of Early Continence after Single-port Transvesical Robot-assisted Radical Prostatectomy. Urology 2024, 184, 176–181. [Google Scholar] [CrossRef] [PubMed]
- Ramos, R.; Shankar, P.R.; Soputro, N.A.; Bullen, J.; Pedraza, A.M.; Chavali, J.S.; Mikesell, C.D.; Ward, R.; Purysko, A.; Kaouk, J. Preoperative Prostate Magnetic Resonance Imaging-based Anatomical Predictors of Early Urinary Continence Following Single-port Transvesical Robot-assisted Radical Prostatectomy. Eur. Urol. Focus 2024. ahead of print. [Google Scholar] [CrossRef] [PubMed]
- Abou Zeinab, M.; Beksac, A.T.; Ferguson, E.; Kaviani, A.; Kaouk, J. Transvesical versus extraperitoneal single-port robotic radical prostatectomy: A matched-pair analysis. World J. Urol. 2022, 40, 2001–2008. [Google Scholar] [CrossRef] [PubMed]
- Harrison, R.; Stifelman, M.; Billah, M.; Zaifman, J.; Lulla, T.; Sanchez De La Rosa, R.; Koster, H.; Lovallo, G.; Ahmed, M. Propensity-Score Matched Analysis Between Extraperitoneal Single Port and Intraperitoneal Multiport Radical Prostatectomy: A Single-Institutional Experience. Urology 2022, 165, 198–205. [Google Scholar] [CrossRef] [PubMed]
- Ko, Y.H.; Jang, J.Y.; Kim, Y.U.; Kim, S.W. Faster both in operative time and functional recovery by the extraperitoneal daVinci SP-based robot-assisted radical prostatectomy: A propensity score matching analysis compared to transperitoneal multiport counterpart. J. Robot. Surg. 2024, 18, 205. [Google Scholar] [CrossRef] [PubMed]
- Jiang, Y.; Liu, Y.; Qin, S.; Zhong, S.; Huang, X. Perioperative, function, and positive surgical margin in extraperitoneal versus transperitoneal single port robot-assisted radical prostatectomy: A systematic review and meta-analysis. World J. Surg. Oncol. 2023, 21, 383. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Goldfarb, M.A.; Protyniak, B.; Schultheis, M. Hostile Abdomen Index Risk stratification and laparoscopic complications. J. Soc. Laparosc. Robot. Surg. 2014, 18, 14–19. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
Before Match | Following Propensity-Matched Analysis | |||
---|---|---|---|---|
Parameter | Multiport Transperitoneal n = 429 | Multiport Transperitoneal n = 121 | Single-Port Extraperitoneal n = 485 | p Value |
Patients Characteristics | ||||
Age, years, mean (95% CI) | 61.9 (61.1–62.7) | 62.2 (60.9–63.5) | 63.6 (63.0–64.2) | 0.05 |
Race, n (%) | 0.36 | |||
Caucasian | 364 (85%) | 101 (83.5) | 428 (88.2) | |
African American | 40 (9.3%) | 12 (9.9) | 33 (6.8) | |
Hispanic | 12 (2.8%) | 8 (6.6) | 24 (5.0) | |
BMI, kg/m2, mean (95% CI) | 29.5 (29–29.9) | 29.1 (28.3–29.9) | 29.5 (29.0–29.9) | 0.45 |
Past surgical history, n (%) a | 123 (31.6%) | 38 (31.4) | 201 (41.4) | 0.043 |
Prostate cancer characteristics | ||||
PSA, ng/mL, mean (95% CI) | 7.3 (6.8–7.8) | 8.2 (7.1–9.3) | 8.3 (7.6–9.1) | 0.87 |
PSAD, mean (95% CI) | 0.24 (0.22–0.26) | 0.18 (0.15–0.21) | 0.2 (0.19–0.24) | 0.13 |
Percentage of positive cores, mean (95% CI) | 39.9 (37.6–42.3) | 42.1 (37.6–46.7) | 38.5 (36.5–40.5) | 0.11 |
Max core involvement in the core with highest GG, mean (95% CI) | 57.1 (54.3–60) | 58.8 (52.8–64.8) | 57.9 (55.3–60.7) | 0.78 |
ISUP GGG, n (%) | 0.25 | |||
1 | 95 (22.1%) | 25 (20.7) | 87 (17.9) | |
2 | 190 (44.3%) | 49 (40.5) | 241 (49.7) | |
3 | 73 (17%) | 25 (20.7) | 95 (19.6) | |
4 | 44 (10.3%) | 12 (9.9) | 41 (8.5) | |
5 | 27 (6.3%) | 10 (8.2) | 21 (4.3) | |
Clinical stage, n (%) | 0.46 | |||
T1c | 336 (78.3%) | 104 (86.0) | 408 (84.1) | |
T2 | 51 (11.9%) | 16 (13.2) | 76 (15.7) | |
T3 | 2 (0.5%) | 1 (0.8) | 1 (0.2) | |
Functional characteristics | ||||
SHIM score, mean (95% CI) | 18.8 (18.2–19.4) | 17.9 (16.6–19.2) | 17.6 (16.9–18.2) | 0.63 |
SHIM score ≥ 17, n (%) | 230 (72.3%) | 71 (58.7) | 299 (61.6) | 0.86 |
IPSS, mean (95% CI) | 8.7 (8–9.4) | 8.8 (7.4–10.2) | 9.3 (8.6–10.0) | 0.51 |
Perioperative characteristics | ||||
Operative time, min, mean (95% CI) | 180 (176.7–183.4) | 181.5 (174.5–188.6) | 198.9 (195.6–202.2) | <0.001 |
EBL, mL, mean (95% CI) b | 236 (218.7–253.4) | 215.9 (188.7–243.2) | 125.1 (113.5–136.7) | <0.001 |
Nerve-Sparing, n (%) | 352 (83%) | 102 (85.0) | 415 (85.6) | 0.87 |
Lymphadenectomy, n (%) | 386 (90.8%) | 110 (90.9) | 310 (63.9) | <0.001 |
Opioids prescribed at discharge, n (%) | 374 (88.8%) | 103 (85.1) | 70 (14.4) | <0.001 |
Length of Stay, hours, mean (95% CI) | 34.2 (32.1–36.4) | 31.9 (28.1–35.6) | 12.6 (10.3–14.8) | <0.001 |
Catheter duration, days, mean (95% CI) | 8.6 (8.2–9) | 8.8 (7.7–9.8) | 6.0 (5.8–6.3) | <0.001 |
Complications, n (%) c | ||||
Intraoperative | 0 | 0 | 1 (0.2) | 0.47 |
Postoperative | 54 (12.8%) | 15 (12.4) | 75 (15.3) | 0.38 |
Readmission, n (%) | 23 (5.4%) | 4 (3.3) | 30 (6.2) | 0.21 |
Pathologic Outcomes | Multiport Transperitoneal n = 121 | Single-Port Extraperitoneal n = 485 | p Value |
---|---|---|---|
Prostate weight, g, mean (95% CI)) | 56.2 (50.0–62.4) | 53.7 (51.0–56.4) | 0.42 |
Pathologic T stage, n (%) | 0.45 | ||
T2 | 55 (45.5) | 239 (49.3) | |
T3a/b | 66 (54.5) | 246 (50.7) | |
Pathologic Lymph Node Stage, n (%) | 0.64 | ||
Nx | 11 (9.1) | 175 (36.1) | |
N0 | 102 (84.3) | 291 (60.0) | |
N1 | 8 (6.6) | 19 (3.9) | |
ISUP GG, n (%) | 0.30 | ||
1 | 7 (5.8) | 25 (5.1) | |
2 | 70 (57.8) | 312 (64.3) | |
3 | 25 (20.7) | 104 (21.5) | |
4 | 5 (4.1) | 11 (2.3) | |
5 | 14 (11.6) | 33 (6.8) | |
Surgical margin details, n (%) a | 0.84 | ||
Negative | 89 (73.5) | 361 (74.4) | |
Limited | 20 (16.5) | 83 (17.1) | |
Non-limited | 12 (10.0) | 41 (8.5) | |
Oncologic outcomes | |||
Freedom from BCR at 60 mos., mean (95% CI) b | 81.7 (81.6–81.8) | 83.0 (82.9–83.1) | 0.36 |
Follow-up, months, mean (95% CI) | 16.3 (12.6–19.9) | 12.6(11.6–13.8) | 0.013 |
Functional outcomes | |||
SHIM, mean (95% CI) | |||
6 weeks | 5.0 (4.8–5.3) | 6.0 (5.6–6.5) | 0.03 |
3 months | 6.0 (5.0–6.9) | 6.9 (6.3–7.6) | 0.14 |
6 months | 6.7 (4.5–9.0) | 8.6 (7.6–9.6) | 0.13 |
0–1 safety pad/day, n (%) | |||
6 weeks | 35 (28.9) | 121 (24.9) | 0.37 |
3 months | 68 (56.2) | 258 (53.2) | 0.55 |
6 months | 95 (78.5) | 391 (80.6) | 0.60 |
12 months | 110 (91.1) | 138 (90) | 0.59 |
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Chavali, J.S.; Pedraza, A.M.; Soputro, N.A.; Ramos-Carpinteyro, R.; Mikesell, C.D.; Kaouk, J. Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis. Cancers 2024, 16, 2994. https://doi.org/10.3390/cancers16172994
Chavali JS, Pedraza AM, Soputro NA, Ramos-Carpinteyro R, Mikesell CD, Kaouk J. Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis. Cancers. 2024; 16(17):2994. https://doi.org/10.3390/cancers16172994
Chicago/Turabian StyleChavali, Jaya S., Adriana M. Pedraza, Nicolas A. Soputro, Roxana Ramos-Carpinteyro, Carter D. Mikesell, and Jihad Kaouk. 2024. "Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis" Cancers 16, no. 17: 2994. https://doi.org/10.3390/cancers16172994