Background

Since the implementation of robotic surgery, the platforms have been updating constantly in terms of arm configuration, tool design, scope settings, and the number of trocars placed. The introduction of new robotic technology is challenging and requires studies followed by technique adaptions.

Objective

This study aims to report a logical and technologically safe approach to the learning curve using the da Vinci single-port (SP) console and describes our robotic-assisted radical prostatectomy (RARP) technique step by step.

Design, setting, and participants

A prospective study from 26 consecutive patients who underwent RARP with the da Vinci SP console from June to August 2019.

Surgical procedure

All surgeries were performed with a transperitoneal technique; one robotic trocar was placed above the umbilicus and one additional 12 mm trocar was placed in the right lower quadrant.

Measurements

We described the step-by-step technique and reported the perioperative and pathological data. In addition, we considered the hospital length of stay and pain scale following surgery. Continuous variables were reported as median and interquartile ranges. Categorical variables were reported as frequencies and proportions.

Result and limitations

The total median operative time was 121 min, console time was 85 min, and blood loss was 50 ml. No complications were reported. In the final pathology, four patients had Gleason 6, 20 had Gleason 7, one had Gleason 8, and one had Gleason 9.Of the patients, 70% were ≤pT2 and 30% were ≥pT3a. Only 11% had positive surgical margins. This study is limited by the small number of patients and a short period of follow-up to evaluate functional and oncological outcomes of this new technology.

Conclusions

RARP with the da Vinci SP is feasible and safe. Therefore, the step-by-step technique described in this study could be considered an option to perform radical prostatectomies. However, we still need better-designed studies to compare the outcomes with those of the multiport platform.

Patient summary

We reported our step-by-step technique describing a safe approach to robotic-assisted radical prostatectomy during the transition from the Xi to the da Vinci single-port robot.

中文翻译：

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实施da Vinci单端口机器人系统所需的技术修改。

背景

自实施机器人手术以来，该平台在手臂配置，工具设计，范围设置和所放置套管针的数量方面一直在不断更新。引入新的机器人技术具有挑战性，需要进行研究，然后进行技术调整。

目的

这项研究旨在报告使用达芬奇单端口（SP）控制台的学习曲线的逻辑和技术上安全的方法，并逐步描述我们的机器人辅助根治性前列腺切除术（RARP）技术。

设计，设置和参与者

这项前瞻性研究来自2019年6月至2019年8月使用da Vinci SP控制台接受RARP的连续26位患者。

手术程序

所有手术均采用腹膜技术。一根机器人套管针放在脐部上方，另一只12 mm套管针放在右下象限。

测量

我们描述了分步技术，并报告了围手术期和病理数据。此外，我们考虑了手术后的住院时间和疼痛程度。连续变量报告为中位数和四分位数范围。分类变量报告为频率和比例。

结果与局限性

总中位手术时间为121分钟，控制台时间为85分钟，失血量为50 ml。没有并发症的报道。在最后的病理学中，有4例Gleason 6、20例Gleason 7、1例Gleason 8、1例Gleason9。其中，70％≤pT2，30％≥pT3a。只有11％的患者手术切缘阳性。这项研究受到患者数量少和评估该新技术的功能和肿瘤学结局的短期随访限制。

结论

使用达芬奇SP的RARP是可行且安全的。因此，在这项研究中描述的逐步技术可以被认为是进行根治性前列腺切除术的一种选择。但是，我们仍然需要设计更好的研究来将结果与多端口平台的结果进行比较。

病人总结

我们报告了逐步的技术，该技术描述了从Xi到da Vinci单端口机器人过渡期间机器人辅助的根治性前列腺切除术的安全方法。