Development of novel patient selection algorithm for multi-port versus single-port robotic radical prostatectomy approaches.

Abstract

Background: The aim of this study was to develop a patient selection algorithm to better guide clinical decision-making towards the different approaches of multi-port (MP) and single-port (SP) robotic radical prostatectomy (RARP).

Methods: A retrospective study was performed on an institutional review board (IRB) -approved database to identify all consecutive patients who underwent transperitoneal MP, extraperitoneal SP, and transvesical SP-RARP between 2018 and 2024. Baseline clinicodemographic variables were collected. Univariate and multivariate regression analyses were used to construct two separate nomograms to predict the likelihood of MP versus SP-RARP as well as extraperitoneal versus transvesical SP-RARP.

Results: RARP was completed in 529 patients, which included 91 (17.2%) transperitoneal MP-RARP, 195 (36.9%) extraperitoneal SP-RARP, and 243 (45.9%) transvesical SP-RARP. All SP cases were successfully completed without the need for conversion or additional ports. When comparing MP versus SP, lower prostate cancer risk categories, smaller prostate glands, and a more significant history of previous abdominal surgery as represented by a higher Hostile Abdomen Index (HAI) were identified as clinically significant predictors of SP-RARP. Within the SP-RARP cohort, all three aforementioned variables and the absence of any adverse features on preoperative magnetic resonance imaging (MRI) favored transvesical over extraperitoneal SP-RARP. Internal validation of the two nomograms demonstrated reasonable performance with an area under the curve (AUC) of 0.73 and 0.77, respectively. Considering the optimal cutoff points of 0.87 and 0.54 for the two models, all cases of SP-RARP and transvesical SP-RARP who scored above the threshold demonstrated superior perioperative outcomes.

Conclusions: Herein, we have developed a novel patient selection algorithm aimed at better guiding clinical decision-making in the evolving landscape of contemporary RARP approaches. The findings highlighted in this study, which was based on more than five years of clinical experience, can be useful for institutions seeking to adopt or expand their SP-RARP practices and to ensure optimal perioperative outcomes.