The Da Vinci Single-Port (SP) Robot, approved for clinical use in the United States in 2018, has revolutionized minimally invasive surgery, including radical prostatectomies. Various approaches, including transperitoneal, extraperitoneal, and transvesical, are utilized. The transvesical (TV) technique offers unique benefits, such as avoiding the peritoneal cavity and eliminating the need for steep Trendelenburg positioning, which can enhance recovery, particularly for urinary continence. Most patients undergoing the transvesical approach experience a streamlined recovery, typically being discharged the same day without the need for narcotic pain relief. This study aims to educate surgeons by showcasing different unique cases encountered during single-port transvesical (SPTV) prostatectomy, emphasizing the learning points crucial for mastering this novel approach.
In reviewing 220 SPTV cases from a single surgeon over the past two years, four cases with distinct challenges were selected to highlight critical insights. The first case demonstrates a careful bladder entry technique in a patient with a bilateral renal transplant to avoid damaging the ureteric orifices. The second case focuses on the intricacies of bladder neck dissection in a patient with a duplicated collecting system, featuring a ureteric orifice positioned at the bladder neck. The third scenario showcases the sparing technique for the endopelvic fascia and dorsal venous complex (DVC), which optimizes both procedural safety and functional outcomes with SPTV robot-assisted radical prostatectomy (RARP). Finally, the fourth case illustrates the standard pelvic lymph node dissection (PLND) performed following prostate removal when required.
Through these cases, we aim to flatten the learning curve for surgeons new to the single-port transvesical approach, providing practical insights that could help avoid potential complications and improve patient outcomes. By sharing these experiences, we contribute to a growing body of knowledge supporting the adoption of SPTV RARP as a safe, effective method for prostate cancer treatment.
