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British Journal of Healthcare and Medical Research - Vol. 10, No. 3

Publication Date: June 25, 2023

DOI:10.14738/bjhmr.103.14929

Gupta, R., Chaulagain, R. P., Gupta, B. K., Nand, L., Ceesay, E., & Xu, W. (2023). Description of Extraperitoneal Single-Port Robot- Assisted Radical Prostatectomy. British Journal of Healthcare and Medical Research, Vol - 10(3). 375-385.

Services for Science and Education – United Kingdom

Description of Extraperitoneal Single-Port Robot-Assisted

Radical Prostatectomy

Radheshyam Gupta

Department of Urology Surgery, Harbin Medical University

Cancer Hospital, Harbin, Heilongjiang, China

Ram Prasad Chaulagain

Department of Gastroenterology and Hepatology, The Second Affiliated

Hospital of Harbin Medical University, Harbin, Heilongjiang, China

Binay Kumar Gupta

Department of Respiratory Medicine, Shanghai Tenth People’s Hospital,

Tongji University School of Medicine, Shanghai 200072, China

Lal Nand

Department of Physiology, Harbin Medical University,

Harbin, Heilongjiang, China

Essa Ceesay

Department of Oncology, Harbin Medical University

Cancer Hospital, Harbin, Heilongjiang, China

Wanhai Xu

Department of Urology Surgery, Harbin Medical University

Cancer Hospital, Harbin, Heilongjiang, China

ABSTRACT

Extraperitoneal SP-RARP (single Port -Robot-assisted radical prostatectomy) is

currently the standard minimally and safe invasive procedure for the surgical

management of localized prostate cancer. When compared to open surgery, it has

been demonstrated that the minimally invasive robotic approach provides

comparable oncologic and functional outcomes with potential benefits, such as

reduced blood loss, a shorter hospital stay, and a quicker recovery time. Due to its

larger scope and early adoption, the transperitoneal RARP approach is typically the

one used most frequently by robotic surgeons. The extraperitoneal approach has,

however, been reported to have similar oncologic outcomes. Extraperitoneal RARP

is less frequently used today because of its alleged technical complexity. However,

this strategy has advantages, especially when peritoneal access is difficult due to

severe adhesions from prior operations. To treat locally advanced prostate cancer,

extraperitoneal SP-RARP is a feasible safe surgical option. Using the more recent

single-port (SP) robotic system or the more traditional multiport robotic system,

both transperitoneal and extraperitoneal approaches can be carried out. With

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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 3, June- 2023

Services for Science and Education – United Kingdom

regard to extraperitoneal RARP, the SP system has seen a rise in popularity due to

its alleged benefits, which include better cosmesis, fewer postoperative analgesic

and opioid needs, and a shorter length of hospital stay. For evidence supporting

these benefits, additional research must be conducted.

Keyword: Extaperitoneal, single-port, radical prostatectomy, prostate cancer, minimally

invasive surgery

INTRODUCTION

In men with locally advanced prostate cancer, radical prostatectomy is the treatment of choice

[1].In the past 20 years, the surgical approach to treating prostate cancer has fundamentally

changed from an open retropubic procedure as was initially described by Millin in 1945 to a

laparoscopic one [2]. The FDA's (Food and Drugs and administration) initial approval of the da

Vinci surgical robotic platform (Intuitive Surgical, Sunnyvale CA, USA) in 2000 is arguably the

single most important factor that has influenced minimally invasive surgery [3]. Widespread

use of robotic technology for radical prostatectomy has been demonstrated by reductions in

postoperative radiation use, perioperative blood loss, and hospital stay time [4]. Robotic

technology may be linked to improved erectile function and urinary continence

postoperatively, despite the fact that there is significant heterogeneity in studies. The most

widely used robotic oncologic procedure in the United States is the robotic prostatectomy [5].

The rapid rate of diffusion of the surgical robot in urology is highlighted by the fact that, by

2013, 85% of all radical prostatectomies were carried out robotically [6]. Since the introduction

of the first da Vinci robotic platform, subsequent iterations have incorporated a multi-arm

design with a fixed laparoscopic camera.

In fact, using robotic assistance during laparoscopic procedures has shown to shorten hospital

stays and decrease perioperative blood loss [4]. Additionally, dubious and contentious research

has suggested that robotic radical prostatectomy may have improved postoperative erectile

function and delivered higher rates of urinary continence compared to other approaches [7].

Over the past 20 years, improved versions of the da Vinci robotic platform have been made

available; these models all feature multiple arms and a fixed laparoscopic camera. Reduced

postoperative pain and complications from incisions were the goal of laparoscopic single-site

surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), which were

intended to take minimally invasive surgery into the future [8]. However, despite their potential

benefits of lowering surgical morbidity, enhancing cosmesis, and decreasing pain. These single- site techniques are still not commonly used due to a number of important factors, including

rigid instrumentation, extremely long surgical time, significant challenges with instrument

clashing, and limited operative space. In 2014 it was initial clinical series of single port (SP)

robotic surgery using a purpose-built robotic platform [9]. The da Vinci Single Port (SP) system

for urologic surgery was authorized by the FDA a few years later, in 2018. This innovative

platform accommodates all the robotic instruments including cameras through a single

multichannel 2.5 cm port inserted through a single skin incision, as opposed to the multiple

trocars commonly employed during standard multiport robotic procedures. The preferred

surgical procedure for treating prostate cancer is robotic-assisted radical prostatectomy

(RALP)[5]. It has typically been carried out via a transperitoneal procedure. Alternative

strategies have been investigated with the SP robotic system in order to maximize the

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Gupta, R., Chaulagain, R. P., Gupta, B. K., Nand, L., Ceesay, E., & Xu, W. (2023). Description of Extraperitoneal Single-Port Robot-Assisted Radical

Prostatectomy. British Journal of Healthcare and Medical Research, Vol - 10(3). 375-385.

URL: http://dx.doi.org/10.14738/bjhmr.103.14929

advantages that this new platform can provide [10]. Since Kaouk et al. [11] first described SP- RALP, numerous centers have reported various methods and results with this novel procedure.

INSTRUMENTS ARMAMENTARIUM FOR DA VINCI SP AND DA VINCI TM

For da Vinci SP, there are seven instruments in the da Vinci SP surgical system. a 10 x 12-mm

flexible camera, a monopolar scissors, a bipolar grasper, a Cadiere grasper, two needle holders,

and an applier for Weck clips. Additional instruments include a GelPOINT" mini advanced from

Rancho Santa Margarita, California, a robotic 25-mm multichannel port, a 12-mm laparoscopic

port, a 14-mm nasogastric tube for suction, and an AirSeal system for insufflation with a

pneumoperitoneum pressure of 12 mmHg (Figure:1 a,b)

Fig1a Fig1b

Fig: 1a, b: Da Vinci SP surgical system shows AirSeal system for insufflation with a

pneumoperitoneum pressure of 12 mmHg.

For The da Vinci TM Surgical System of robotic surgical system consisting with three main

components: The InSiteTM Vision System offers the surgeon a real minimally invasive 3-D

perspective of the surgical field. The EndoWristTM Instruments are part of the surgical cart. The

EndoWrist instruments are made to move like a human hand, wrist, and finger. The master

controls for operating the EndoWrist instruments are located on the surgeon console. Using the

da Vinci Surgical System has the following advantages: The capacity for the surgeon to do

intricate minimally invasive treatments in the same method as open surgery procedures

without experiencing the tiredness associated with an extended procedure. Numerous

advantages for the patient are achievable with current laparoscopic techniques, including less

bleeding, less pain, a lower risk of internal scarring, a short hospital stay and a quicker recovery.

The movements of the human hand, wrists, and fingers are faithfully replicated by the

EndoWrist instruments. A wide range of motion enables precise tissue manipulation,

dissection, and suturing. Dual 3-chip digital cameras on the InSiteTM Vision System allow for

"inside" surgery on patients. Depth of field and resolution are offered by the sole technology

with genuine 3-D vision. The natural hand-eye coordination required for open surgery is

provided by a 3-D image positioned over the master controls. Vision system on-site scope of an

onsite vision system. The da Vinci Surgical System from Intuitive Surgical, Inc., is an enabling

the next generation of surgery. The da Vinci Surgical System, which combines the most recent

developments in robotic and computer technology, is the only operative surgical robot that has

been approved by the US Food and Drug Administration as being safe and effective for