Clinical observation of modified single incision robot-assisted laparoscopic radical prostatectomy

Abstract

Objective

To retrospectively analyze the feasibility and clinical efficacy of modified single incision robot-assisted laparoscopic radical prostatectomy.

Methods

From November 2020 to August 2021, 203 cases of modified single incision (without special channel devices) robot-assisted laparoscopic radical prostatectomy through extraperitoneal approach were reviewed. The average age of the patients was 69 (53–89) years, and the median prostate-specific antigen (PSA) level was 10.89 (2.89, 56.44) ng/ml; Gleason score was 7.0 (6.0–9.0), including 30 cases (14.8%), 108 cases (53.2%) and 65 cases (32.0%) with scores ≤ 6, 7 and ​≥ 8 respectively; prostate volume was 59.0 (24.0–200.0) ml. Body mass index (BMI) ​≤ ​25 and ​> 25 ​kg/m² were 125 cases (61.6%) and 78 cases (38.4%) respectively. Clinical stage was < cT3a in 191 cases, cT3a in 12 cases; 35 cases had a history of abdominal surgery. All operations were performed by the same surgeon in the center. The operation related indexes, postoperative recovery, pathology and follow-up results were observed.

Results

203 operations were successfully performed as planned. The average operation time was 55.07 (37–129) min; the intraoperative blood loss was 68.3 (40–228) ml; the average time of postoperative exhaust was 1.3 (0.5–3.0) days; the average retention time of urinary catheter was 7.2 (6–14) days; the average hospitalization time was 7.5 (6–15) days. Postoperative sepsis occurred in one case. The postoperative Gleason scores ≤ 6, 7 and ​≥ 8 were 42 cases (20.7%), 132 cases (65.0%) and 29 cases (14.3%). The postoperative pathological stage was < pT3a in 172 cases (84.7%) and ≥ pT3a in 31 cases (15.3%); 38 cases (18.7%) had positive margin after operation. 154 patients (75.9%) were satisfied with urinary control immediately after removing the urinary catheter, and 173 patients (85.2%) were satisfied with the recovery of urinary control within one month after operation (defined as the use of urinary pad ≤ 1 piece in 24 ​h). PSA < 0.2 ​μg/ml at six weeks after operation was in 170 patients (83.7%). The average incision length was 5.91 (5.0–6.8) cm.

Conclusion

The modified single incision robot-assisted laparoscopic radical prostatectomy through extraperitoneal approach is safe and feasible. The clinical effect is satisfactory, and the modified method is not limited by specific special channel devices, so it is easy to be applied in clinical practice.