Abstract
We aim to investigate the peri-operative outcomes after extraperitoneal single-port based robot-assisted radical prostatectomy (eSP-RARP) utilizing the da Vinci SP system compared to conventional transperitoneal multi-port counterparts (tMP-RARP), in an era when pelvic lymph node dissection (PNLD) was omitted for the node-negative case. With exclusion criteria of volume + 50g, suspicious rectal invasion, and node-positive disease given relatively weak grasping power and limited range of motion from the current SP system, 50 consecutive patients (Since December 2021) with localized prostate cancer underwent eSP-RARP by a single urologist maintaining identical surgical technique for 100 consecutive tMP-RARP cases (Since December 2020). Given initial selection criteria, each group was matched to a 1:1 ratio based on the risk-stratification parameters and the prostate volume. The operative time, which was maintained in each group during the study period, was significantly faster in eSP-RARP groups than in tMP-RARP (149.2 vs. 163.2 minutes, p = .025), while the weight of the removed specimen (27.1 vs. 29.0 g, p = .420) and margin positivity (14.7% vs. 11.7% in pT2, p = .812) were similar. The gas-out (1.5 vs. 1.88 days, p = .003) and solid diet dates (2.26 vs. 3.22 days, p < .001) were faster in the eSP-RARP group. The single-pad continence dates (30.5 vs. 51.9 days, p = .145) and zero-pad continence dates (105.5 vs. 146.2 days, p = .210) were identical. 90-day single-pad continence rate was 92% vs. 82% (p = .142, 52% vs. 56% in zero-pad continence). Based on these, daVinci SP-based RARP restored bowel function faster with shorter operative time through an extraperitoneal approach than the conventional transperitoneal multi-port counterpart while maintaining similar incontinence outcomes in cases without a routine PNLD.