Study supports use of single port robotic prostatectomy for large-gland BPH

The single port robotic prostatectomy produced impressive clinical and functional outcomes in patients with large-gland benign prostatic hyperplasia (BPH), according to study results presented during the 2021 AUA Annual Meeting.1

At a mean follow-up of 7.4 months after patients received this single incision transvesical approach, the mean International Prostatism Symptom Score (IPSS) improved from 23.2 to 5.78, and the average post-void residual (PVR) urine level dropped from 227.9 ml to 25.1 ml. Further, no men reported de novo stress urinary incontinence (SUI), and only 5 of 51 men reported de novo urge urinary incontinence. The average number of catheterized days was 7.

Providing background for the study, first author Susan Talamini, MD, a urology resident at the University of Illinois at Chicago said, “The treatment of large-gland BPH can pose significant surgical challenges. AUA guidelines recommend consideration of open, laparoscopic, or robot-assisted prostatectomy as treatment options by clinicians, depending on their expertise with these techniques, only in patients with large to very large prostates, >80 gm. The recommendation is categorized as Moderate, with a Grade C evidence level.”

The single port da Vinci SP surgical system received FDA clearance for urologic use in June 2018. The system is used in a wide variety of surgical procedures, including radical and simple prostatectomy, radical and partial nephrectomy, retroperitoneal surgery, pyeloplasty, and vaginoplasty.

“The single port is particularly effective for working confined spaces, including retroperitoneal and transvesical approaches, and therefore, has found a unique place in the approach to the simple prostatectomy,” explained Talamini.

The prospective, multi-institutional study presented during the AUA meeting enrolled 51 men with large-gland BPH undergoing single port robotic assisted simple prostatectomy. The surgeries were performed at 2 institutions that both had a very high volume of single port robotic surgery. The 2 surgeons who performed the surgeries had extensive experience, having performed single port procedures at a high volume.

The average patient age was 69.5 years and the average body mass index was 25.7 kg/m2. The average estimated blood loss was 209.7 ml. Regarding pathology, 48 men had BPH, and 3 men had incidentally found prostate cancer (GG1, GG2, and GG3). The mean dry weight of the removed specimen was 91.4 gm and the average time of operation was 172.2 minutes.

In her concluding remarks, Talamini commented on some of the specific aspects of the single port procedure that helped lead to the successful study results.

“The single 3-cm incision and small cystotomy due to the ‘floating dock’ approach allow for a significantly less invasive approach to robotic simple prostatectomy, as compared to the multiport procedure,” said Talamini. “Also, the ability to perform bladder neck reconstruction with the single port represents a significant advantage as compared to endoscopic approaches for large and very large gland BPH. We suspect that the excellent postoperative continence rates may be due to the bladder neck reconstruction allowed by the single-port approach.”

Reference

1. Talamini S, Zeinab MA, Zuberek M, et al. Prospective Multi-Institutional Analysis of Single Port Simple Prostatectomy Outcomes. Presented during the 2021 American Urological Association Annual Meeting; September 10-13, 2021. LBA01-08.