Introduction: The da Vinci SP® surgical platform has allowed for the development of novel surgical techniques for radical prostatectomy. Robotic-assisted laparoscopic radical prostatectomy is usually followed by an overnight hospital stay. This study assesses the safety and feasibility of extraperitoneal single-port robotic radical prostatectomy as an outpatient procedure.
Methods: 60 consecutive patients with clinically localized prostate cancer underwent extraperitoneal single-port robotic radical prostatectomy by a single high-volume surgeon. Local anesthesia was used intraoperatively to infiltrate the rectus fascia as well as the skin. Minimal intraoperative fluids and in-hospital opiates were used as part of an outpatient enhanced recovery protocol. Patients were discharged the day of surgery if they were ambulatory, tolerating a regular diet and had controlled pain, regardless of surgical start time or case order. All patients were
offered the option to stay overnight even if meeting these milestones. Patient data was collected prospectively in an institutional review board-approved database and evaluated retrospectively.
Results: All surgeries were completed in an extraperitoneal fashion with bilateral pelvic lymph node dissection. Mean operative time was 198 minutes with mean estimated blood loss of 179 mL. There were no intraoperative complications and no patients received a blood transfusion. 73% of patients were discharged on the date of surgery with a median length of stay of 4.2 hours. Final pathology revealed positive margins in 14 patients; however, 8 of these patients had pT3a disease, 5 had gleason 4+5 or 5+4 = 9 disease at final pathology and 4 of these patients were pN1. While 53% of patients were discharged with an opiate prescription, the discharge prescribing practice was changed during the series with only 10% of the last 30 patients in the series receiving opiate prescriptions at discharge. There were no emergency room visits for postoperative pain
control. 7 patients had Clavien 3a complications (6 symptomatic lymphoceles requiring drainage and 1 urinoma requiring drainage). Of the patients with available 4-6 week follow up, 49% were requiring 0-1 pads per day (n=41).
Conclusions: Extraperitoneal single-port robotic radical prostatectomy can be performed safely as an outpatient procedure without the need for postoperative opiates in the majority of patients. Source of