Abou Zeinab Mahmoud, Beksac Alp Tuna, Ferguson Ethan, Kaviani Aaron, Moschovas Marcio Covas, Joseph Jean, Kim Moses, Crivellaro Simone, Nix Jeffrey, Patel Vipul, Kaouk Jihad
Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
Global Robotics Institude, Celebration, FL.
Urology. 2023 Jan;171:140-145. doi: 10.1016/j.urology.2022.10.001. Epub 2022 Oct 13.
To compare the perioperative and early postoperative outcomes between single-port (SP) extraperitoneal radical prostatectomy (EPRP) and SP transperitoneal radical prostatectomy (TPRP), in a multi-institutional setting.
We identified all patients who underwent SP robot-assisted radical prostatectomy at 6 different institutes. Data of 650 patients were collected and divided into 2 groups based on the surgical approach: SP EPRP or SP TPRP. A Propensity-score matched-pair analysis for body mass index (BMI), prostate size, and National Comprehensive Cancer Network risk was performed with a 1:1 ratio. Analysis of perioperative and postoperative outcomes was performed using Wilcoxon signed-rank test and chi-square and Fisher's exact tests.
After matching, 238 patients were included in each arm. The median follow-up period was 7 and 6 months for EPRP and TPRP groups, respectively. The total operative time was longer in the EPRP group (206 vs 155 minutes, P < .001). The EPRP group had a shorter length of hospitalization and same-day discharge rate compared to the TPRP approach (P < .001). There was no difference in the overall intraoperative or postoperative complications rate between the 2 groups, nor positive surgical margin rates.
The SP extraperitoneal approach is associated with a shorter hospital stay and higher rate of same-day discharge, with no difference in the surgical margin, or complication rates.
在多机构环境中比较单孔（SP）腹膜外根治性前列腺切除术（EPRP）和SP经腹根治性前列腺切除术（TPRP）的围手术期及术后早期结局。
我们确定了在6家不同机构接受SP机器人辅助根治性前列腺切除术的所有患者。收集了650例患者的数据，并根据手术方式分为2组：SP EPRP或SP TPRP。对体重指数（BMI）、前列腺大小和美国国立综合癌症网络风险进行倾向评分匹配对分析，比例为1:1。使用Wilcoxon符号秩检验、卡方检验和Fisher精确检验对围手术期和术后结局进行分析。
匹配后，每组纳入238例患者。EPRP组和TPRP组的中位随访期分别为7个月和6个月。EPRP组的总手术时间更长（206分钟对155分钟，P <.001）。与TPRP手术方式相比，EPRP组的住院时间更短，当日出院率更高（P <.001）。两组的总体术中或术后并发症发生率以及切缘阳性率均无差异。
SP腹膜外手术方式与较短的住院时间和较高的当日出院率相关，切缘或并发症发生率无差异。
