Robotic Transvesical Partial Prostatectomy Using a Purpose-Built Single Port Robotic System (Video)

By Jihad Kaouk, MD

Partial prostatectomy has been proposed as an alternative treatment for energy-based ablation of localized prostate cancer. We undertook a study to evaluate the feasibility of a transvesical robotic approach for partial prostatectomy (SP-TVPP) using a novel purpose-built single port surgical platform in a preclinical model.

Method

Three male cadavers were placed in a lithotomy position. A 3 cm midline incision was made in the suprapubic area 4 cm from the symphisis pubis. After opening the Retzius space, a single-port mini device (GelPOINT, Rancho Margarita, California) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, California) was docked to the GelPOINT by inserting a novel single port cannula through the GelSeal Cap.

En bloc anterior prostatectomy were performed with these surgical steps:

1. Retrograde dissection of prostate base at the bladder neck.
2. Lateral excision of a defined prostate peripheral zone.
3. Urethrovesical anastomosis.

Results

All cases were completed successfully without conversion or the need for additional ports. Mean total operative time was 49.3 minutes. Step-specific times are listed in Table 1.

Conclusion

Transvesical robotic partial prostatectomy proved feasible with a novel purpose-built single port surgical platform in a cadaver model. Future clinical evaluation is needed to assess its effectiveness in patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques are warranted.

This video was produced with the help of Clinical Fellows Daniel Sagalovich, MD, and Juan Garisto, MD. Intuitive Surgical provided funding.