Extraperitoneal single-site robot-assisted radical prostatectomy with extended pelvic lymph node dissection: technique and experience

Abstract

Introduction

For patients with locally advanced or high-risk localised prostate cancer who require lymph node dissection (LND), guidelines recommend an extended pelvic LND (ePLND). Such an extensive dissection ensures accurate staging information for most patients [1]. Advancements in surgical instrumentation and optimisation of surgical techniques could potentially empower surgeons to perform an ePLND in a more minimally invasive manner.

Extraperitoneal single-site or single-port robot-assisted radical prostatectomy (ESSRARP) has emerged as an intriguing concept. However, data from SSRARP with PLND studies have presented a less promising picture. The median number of lymph nodes (LNs) removed using the ESSRARP approach was only five [2, 3]. Compared with the transperitoneal anterior approach, the main difficulties for ePLND through an extraperitoneal approach are restricted workspace and a high incidence of symptomatic lymphocele [4, 5]. Exploring bridge technique is particularly interesting and appears to serve as good training for transitioning to the use of the single-port platform. Our primary aim in this study was to describe the surgical steps and technique of the ESSRARP with ePLND, along with the preliminary data.