Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Endourol. 2024 May;38(5):450-457. doi: 10.1089/end.2023.0652. Epub 2024 Apr 1.
Following its introduction in 2018, the Single-Port (SP) robotic platform has been increasingly utilized for various approaches of robotic radical prostatectomy (RARP). Despite the demonstrable benefits in enhancing postoperative outcomes, there has been limited evidence on its perioperative morbidity, especially when compared to the gold-standard multiport (MP). This study sought to compare the perioperative morbidity between SP and MP-RARP. A retrospective review was performed on 911 patients who underwent RARP between January 2015 and May 2023. At our institution, SP-RARP has been performed since October 2018 with Extraperitoneal and Transvesical (TV) techniques. To reduce the risk of selection bias, only MP-RARP cases performed before October 2018 were included. Baseline clinicodemographic and perioperative parameters were collected. Perioperative complications were classified in accordance to the Clavien-Dindo system with postoperative complications and readmission reported within 90 days of surgery. Statistical analysis was performed with R Packages for Statistical Computing with descriptive statistics as presented. Of the 484 SP and 322 MP-RARP cases included in our analysis, one intraoperative complication was reported, which pertained to a small enterotomy during TV SP-RARP. Postoperative complications were identified in 14.5% and 14.6% of SP and MP-RARP cases ( = 0.989), respectively. Major complication represents 4.1% of the SP and 3.4% of MP cohorts. The 90-day rates of hospital readmission following SP and MP-RARP were 5.6% and 4.9%, respectively ( = 0.717). Limitations of this study included the retrospective single surgeon, single institution nature of our series that also included the early learning curve experience associated with the novel SP platform. This comparative study provided evidence highlighting the low rates of perioperative complication and readmission following SP-RARP that were comparable to the Transperitoneal MP approach. The low morbidity associated with SP-RARP supports its wider application as an addition to the contemporary minimally invasive surgical armamentariums for prostate cancer.
自 2018 年推出以来,单端口(SP)机器人平台已越来越多地用于机器人根治性前列腺切除术(RARP)的各种方法。尽管在改善术后结果方面具有明显的优势,但关于其围手术期发病率的证据有限,尤其是与金标准多端口(MP)相比。本研究旨在比较 SP 和 MP-RARP 的围手术期发病率。我们对 2015 年 1 月至 2023 年 5 月期间接受 RARP 的 911 名患者进行了回顾性研究。在我们的机构中,自 2018 年 10 月以来一直进行 SP-RARP,采用腹膜外和经膀胱(TV)技术。为了降低选择偏倚的风险,仅包括 2018 年 10 月之前进行的 MP-RARP 病例。收集了基线临床病理参数和围手术期参数。根据 Clavien-Dindo 系统对围手术期并发症进行分类,并报告了术后 90 天内的并发症和再次入院情况。使用 R 软件包进行统计分析,采用描述性统计方法进行分析。在我们的分析中,包括 484 例 SP 和 322 例 MP-RARP 病例,报道了 1 例术中并发症,即 TV SP-RARP 期间的小肠切开术。SP 和 MP-RARP 病例的术后并发症分别为 14.5%和 14.6%( = 0.989)。主要并发症分别占 SP 和 MP 队列的 4.1%。SP 和 MP-RARP 后 90 天的住院再入院率分别为 5.6%和 4.9%( = 0.717)。本研究的局限性包括回顾性单外科医生、单机构的研究系列,其中还包括与新型 SP 平台相关的早期学习曲线经验。这项比较研究提供了证据,表明 SP-RARP 术后并发症和再入院率低,与经腹腔 MP 方法相当。SP-RARP 相关的低发病率支持其作为前列腺癌当代微创外科武器库的补充的更广泛应用。