Presented by: Tonya S. King PhD
Sarasota Memorial Health Care System Research Institute

Introduction

Although da Vinci single port prostatectomy (SPP) has been reported to have equivalent outcomes to da Vinci Xi transperitoneal prostatectomy (XiTPP) in selected institutions with expert surgeons who are performing both procedures, less is known about how well SPP compares to XiTPP when implemented into a hospital system with surgeons of varying degrees of training, expertise, and experience.

Materials

Data was collected from an IRB-approved prospectively maintained database of robotic prostatectomy (RALRP) in a tertiary care hospital.  From December 15, 2022, to June 1, 2023, 148 consecutive patients underwent XiTPP with fellowship-trained surgeons, each with more than 15 years of experience with XiTPP.  In the same time period, 22 patients underwent SPP with a different surgeon.   Operative and peri-operative data were collected and analyzed with ­­­­­SAS statistical software.

Results

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Median age was 70 for SPP and 72 for XiTPP.  Median surgery time was 242.5 min (167-655 min to max) for SPP and 105 min (61–169 min to max) for XiTPP, p<0.001.  SPP patients were more likely to have a positive margin > 3mm than XiTPP (38.1% vs. 8.5%, respectively, p=0.001). Transfusion rate was 2/21 (9.5%) for SPP and 1/148 (0.68%) for XiTPP, p=0.044.  Risk of having a hospital length of stay of more than two nights was 16.7% for SPP and 0% for XiTPP, p=0.001.  Median estimated blood loss was 300 cc (50-1700 cc) for SPP and <50 cc for XiTPP, p<0.001.  The median prostate weight was larger for XiTPP (52 g) than SPP (45.5 g), although not statistically significant, p=0.06, and there was a higher percentage of EPE and SVI in the XiTPP patients, although not statistically significant.  There was no significant difference in preoperative hemoglobin or Gleason Grade Group, but XiTPP patients were higher stage (T2 58% and >T3 42%) than SPP (T2 73% and >T3 0%), p<0.001. The presence of a surgical margin greater than 3 mm is significantly higher for SPP (38.1%) than XiTPP (8.5%). 

Conclusion

This study reveals a marked statistically significant difference between operative quality and outcomes for patients undergoing XiTPP vs SPP at a large county hospital.  XiTPP patients fare better than SPP patients in all intra and perioperative parameters.  Although SPP patients were lower stage than TPP patients, SPP patients were 10.7 x more likely to have a positive margin > 3 mm (95% CI 2.5-45.2), with adjustment for stage; 13.5 x more likely to have a transfusion (95% CI 1.3-142.3), ­­­­131% longer median time under general anesthesia, 500% larger median blood loss, and more likely to have a prolonged hospital stay.  When such discrepancies are apparent between SPP and XiTPP, hospitals should establish and enforce standards for the protection of patient safety and oncologic outcomes.

Funding

None.

Lead Authors

Genesis G. Dolgetta, BS
Sarasota Memorial Health Care Research Institute

Robert I. Carey, MD, PhD
Sarasota Memorial Health Care System

Co-Authors

Christopher W. Guske, MD
Sarasota Memorial Health Care System

Benjamin J. Behers, MD
Florida State University College of Medicine

Maximilian S. Carey,
Sarasota Memorial Health Care System

Karim Ghazli,
Sarasota Memorial Health Care System