Single port radical prostatectomy as a viable option for highly complex patients: a single center experience.

To explore the safety and feasibility of the Da Vinci® Single-Port (SP) platform in Robotic-Assisted Radical Prostatectomy (SP-RARP), aiming to provide a viable option for patients with surgical and medical complexities that might otherwise limit their access to common minimally invasive technique. Data from 60 medically and surgically highly complex patients undergoing SP-RARP between December 2018 and December 2023 were analyzed. Variables included patient characteristics, surgical history, intraoperative and postoperative outcomes. Statistical analysis was conducted using Stata® 17.0. Fifty-three percent of cases had a hostile abdomen (HA) (≥1 major abdominal surgery), and 47% were medically highly complex (American Society of Anesthesiologists score ≥3, Charlson Comorbidity Index ≥5 and a Body Mass Index ≥30). The extraperitoneal approach was used in 56% of HA cases and 68% of MHC cases. Intraoperative complications occurred in 12%, exclusively with the transperitoneal approach in HA cases. Postoperative complications (Clavien Dindo ≥3) were 6% and 14%, respectively, with no significant difference between approaches. Same-day discharge was possible in 44% of HA cases and 54% of MHC cases, with significant statistical differences favoring the extraperitoneal approach in both groups. SP-RARP, particularly the extraperitoneal approach, is a viable option for highly complex and challenging cases, providing acceptable oncological and functional outcomes. Prospective studies are crucial for further validating the safety and feasibility of SP-RARP in this patient population.

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Declaration of Competing Interest 1) Greta Pettenuzzo: no conflict 2) Francesco Ditonno: no conflict 3) Donato Cannoletta: no conflict 4) Luca Morgantini: no conflict 5) Ruben Calvo Sauer: no conflict 6) Juan R Torres-Anguiano: no conflict 7) Francesco Montorsi: no conflict 8) Alberto Briganti: no conflict 9) Alessandro Veccia: no conflict 10) Alessandro Antonelli: no conflict 11) Simone Crivellaro: consultant for Intuitive Surgical Inc.