Single Port Approach for Robot-Assisted Radical Prostatectomy

The recent Food and Drug Administration (FDA) approval of the purpose-built da Vinci Single-Port (SP) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in 2018 offers the opportunity to expand the current surgical treatment options for prostate cancer. This new robotic platform showcases a number of unique features that make it an attractive alternative to the conventional multiport robotic system, including the ability to operate in a smaller, deeper space and ability of the instruments to triangulate and move without clashing. Since its approval, the SP robot has been utilized at multiple institutions who have since published initial experiences and outcomes for various approaches to the SP robotic-assisted radical prostatectomy (SP-RARP). These include the transperitoneal, extraperitoneal, Retzius-sparing, perineal, and transvesical approaches. While outcomes data continues to be collected, the basic steps and considerations for each approach is described along with preliminary data detailing advantages and functional outcomes of various approaches. This chapter aims to introduce the features and techniques that make the SP system unique and different from the multiport, describe currently published approaches to the robotic prostatectomy that utilize this state-of-the-art technology, summarize post-operative outcomes, and pose future perspectives to be considered.