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Purpose <p>The optimal surgical approach (transperitoneal vs. extraperitoneal) for single-port robot-assisted radical prostatectomy (SP-RARP) remains a subject of ongoing debate, with limited high-quality evidence to compare their safety and efficacy. This study aimed to compare the safety, effectiveness, and functional outcomes of transperitoneal (SP-TPRP) and extraperitoneal (SP-EPRP) approaches in SP-RARP using propensity score matching (PSM).</p> Methods <p>This retrospective study analyzed 211 consecutive patients who underwent SP-RARP at a tertiary referral center (2018–2024): 58 SP-TPRP and 153 SP-EPRP. PSM was performed to balance baseline covariates. Perioperative outcomes were compared between the two groups. Time to urinary continence recovery was assessed using Kaplan-Meier analysis.</p> Results <p>After PSM, 55 patients per group were analyzed. The SP-EPRP group demonstrated significantly higher estimated blood loss (150.0 vs. 100.0 mL, <i>p</i> = 0.021) and a shorter hospital stay (1 vs. 2 days, <i>p</i> &lt; 0.001), and lower pain scores(0.0 vs. 4.0, <i>p</i> &lt; 0.001). Gastrointestinal complications occurred exclusively in SP-TPRP (<i>n</i> = 5), while lymphoceles only in SP-EPRP (<i>n</i> = 4). No significant differences were found in operative time, overall complications, short-term oncological outcomes or function recovery. Kaplan-Meier analysis showed no significant difference in time to continence recovery between approaches (<i>p</i> = 0.32).</p> Conclusions <p>Both approaches achieve comparable oncological outcomes, perioperative safety, and functional recovery. SP-EPRP was associated with shorter hospital stay and lower early postoperative pain, but higher estimated blood loss. Both approaches appear clinically feasible, and prospective studies with longer follow-up are warranted to validate these findings.</p>

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Safety and efficacy of different surgical approaches in single-port robot-assisted radical prostatectomy based on propensity score matching analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Jin-Chun Qi,
  • Liang Liu,
  • Sheng Tang,
  • Hao-Xuan Yang,
  • Lorenzo Santodirocco,
  • Ying-Ran Xia,
  • Luca Alfredo Morgantini,
  • Ruben Sauer Calvo,
  • Chang-Bao Qu,
  • Ya-Xuan Wang,
  • Simone Crivellaro

摘要

Purpose

The optimal surgical approach (transperitoneal vs. extraperitoneal) for single-port robot-assisted radical prostatectomy (SP-RARP) remains a subject of ongoing debate, with limited high-quality evidence to compare their safety and efficacy. This study aimed to compare the safety, effectiveness, and functional outcomes of transperitoneal (SP-TPRP) and extraperitoneal (SP-EPRP) approaches in SP-RARP using propensity score matching (PSM).

Methods

This retrospective study analyzed 211 consecutive patients who underwent SP-RARP at a tertiary referral center (2018–2024): 58 SP-TPRP and 153 SP-EPRP. PSM was performed to balance baseline covariates. Perioperative outcomes were compared between the two groups. Time to urinary continence recovery was assessed using Kaplan-Meier analysis.

Results

After PSM, 55 patients per group were analyzed. The SP-EPRP group demonstrated significantly higher estimated blood loss (150.0 vs. 100.0 mL, p = 0.021) and a shorter hospital stay (1 vs. 2 days, p < 0.001), and lower pain scores(0.0 vs. 4.0, p < 0.001). Gastrointestinal complications occurred exclusively in SP-TPRP (n = 5), while lymphoceles only in SP-EPRP (n = 4). No significant differences were found in operative time, overall complications, short-term oncological outcomes or function recovery. Kaplan-Meier analysis showed no significant difference in time to continence recovery between approaches (p = 0.32).

Conclusions

Both approaches achieve comparable oncological outcomes, perioperative safety, and functional recovery. SP-EPRP was associated with shorter hospital stay and lower early postoperative pain, but higher estimated blood loss. Both approaches appear clinically feasible, and prospective studies with longer follow-up are warranted to validate these findings.