Comparison of Robotic Assisted Laparoscopic Radical Prostatectomy: SP versus XI, a Single Surgeon Experience

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Sathe, Matthew J. Watson, Amar Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3146651/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Sep, 2023 Read the published version in Journal of Robotic Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction Currently there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to compare our single-institution single-surgeon SP RALP experience to our XI RALP experience with regards to patient selection, perioperative data, and outcomes. Methods Patients who underwent prostatectomy at our institution between August 2019 to April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one urologist at our institution to limit inter-surgeon variability. Demographic and clinical information were extracted from the medical record in standardized fashion. All documented classifications were graded using the Clavien-Dindo classification system. Patients with previous prostate cancer therapies were excluded. Categorical variables were compared using Chi-square or Fisher’s exact test where appropriate. Continuous variables were compared using t-tests or Wilcoxon rank sum tests where appropriate. Results: Complete records were available for 208 patients. Of the total patient population 127 (61.1%) underwent SP prostatectomy compared to 81 (38.9%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65 vs. 66 years; p = 0.60), BMI (29.2 vs 30.1; p = 0.22), preop ASA score > = 3 (68.5% vs. 64.2%; p = 0.52), or preop PSA (7.1 vs. 7.4, p = 0.94). There no difference in procedure time for SP prostatectomy (170 vs. 168 min, p = 0.035), estimated blood loss (100 vs. 100 mL; p = 0.14), or average length of stay (1 vs. 1 days; p = 0.22). There was a significant difference in Gleason grade group between the two cohorts with patients undergoing XI RALRP more likely to have higher stage disease (p = 0.025) and a trend towards higher D’Amico risk scores in the XI group (p = 0.053). There was no difference in rate of positive surgical margins (29.9% vs. 29.6%; p = 0.96). There was no difference in the distribution of complications between the two groups (p = 0.99) with 89% of patients having no complication. There was no difference in the number of lymph nodes removed by modality (p = 0.94). Conclusions : To date, this study represents one of the largest cohorts of patients who underwent SP RALP. Importantly, it is among the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to minimal differences in patient factors, perioperative results, or outcomes between the platforms. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising outcomes. Introduction Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP) is the current standard for the treatment of clinically significant prostate cancer (CSPCa). The minimally invasive approach offers patients excellent results with respect to postoperative recovery and cosmesis while granting the surgeon increased dexterity and visualization [ 1 ] . Currently, the DaVinci surgical system (Intuitive Surgical; Sunnyvale, CA) is the leading platform for robotic urologic surgery and is FDA-approved since the early 2000s. Robotic surgery confers increased benefits in reducing morbidity and improving patient satisfaction, but is associated with a significant level of investment both in the purchasing and regular maintenance of the system in its life cycle [ 2 ] . Furthermore, with each iteration of the technology, there exists a need for a head-to-head comparison with older models to determine any added value for patients, physicians, and hospital systems. If a new platform cannot be proven to provide at least as good of outcomes as an older generation, then its widespread adoption should not occur. In 2018, a model now known as the Davinci Single-Port (SP) received FDA approval for urologic procedures [ 15 ] . The SP system relies on just a single surgical incision to deliver multiple articulating tools into the body. Initial case reports from small series have deemed the DaVinci SP to show promise in terms of safety and efficacy [ 3 ] . However, there is currently a paucity of data directly comparing RALRP outcomes between the SP system and its predecessor, the DaVinci Xi. Our objective was to analyze SP RALRP outcomes and compare them to Xi outcomes at a single tertiary care academic medical center using a single-surgeon control to avoid possible inter-surgeon bias. Methods All patients had biopsy confirmed CSPCa, defined as Gleason grade group 2 or higher. All underwent RALRP with curative intent. All surgeries were performed by a single surgeon (AS) at a tertiary care academic center in the United States. The cohort included 127 consecutive SP cases performed from December 2018 to April 2021, which represents the time frame from which the SP platform began being used at our institution for RALRP. Likewise, 81 consecutive XI cases from March 2018 – April 2021 were selected for comparison. The dates of the comparison XI cohort were selected in order to compare a contemporaneous cohort of XI RALRP patients in order to obtain a real-world comparison given the widespread adoption of the XI platform. Patients with previous prostate cancer therapies were excluded (e.g. brachytherapy, radiation, cryoablation). Preoperative patient variables included mean age, race, average BMI, PSA, ISUP Gleason grade group, ASA score dichotomized as ≤2 or ≥3, and prostate volume (as assessed on preoperative prostate MRI or CT where MRI unavailable). Perioperative outcomes of interest included procedure time, length of stay, final estimated blood loss (EBL), length of stay (LOS), incidence of complications and histopathologic data. Procedure time was recorded as time from incision to completion of closure. Complications were assessed with the Clavien-Dindo classification system [ 13 ] . Histopathological data included grade group, tumor stage, positive surgical margins, and node yield.. All pathology slides were reviewed by the same pathologist who specializes in GU pathology. Variables were analyzed using STATA statistical software, version 16 (StataCorp. 2019 College Station, TX). Chi-square, Fisher’s exact test, paired t-tests, and Wilcoxon rank sum tests were used where appropriate. Results There were no statistically significant differences between the SP and XI cohorts in terms of mean age (65 vs 66 years; p = 0.60), BMI (29.2 vs 30.1 kg/m 2; p = 0.22) ASA score ≥3 (68.5% vs 64.2%; p = 0.53), or prostate volume (46.1 g v 47.5 g, p = 0.69). There was a trend towards a higher D’Amico risk score among patients undergoing XI RALP (37.0%) as compared to SP RALP (21.6%) though this failed to achieve statistical significance (p = 0.053) [Table 1 ]. There was no difference in the median procedure time (170 v 168 min, p = 0.35), median EBL (100 v 100 ml, p = 0.14), or median LOS (1 vs 1 day p = 0.22) [Table 2 ]. On histopathological analysis we found that XI RALP was significantly more likely to be performed on higher grade group disease (p = 0.025). There was no significant difference in pathological tumor stage (p = 0.61), positive surgical margins (29.9% vs 29.6%; p = 0.96), or median number of lymph nodes removed (3 vs 3 nodes; p = 0.94) between the two cohorts [Table 3 ]. There was no difference between the groups with Clavien complications (p = 0.99), with 89% of patients in both groups experiencing no complications. In the SP cohort twelve patients (9.5%) experienced a grade 1 complication, one patient (0.8%) experienced a grade 3 complication (pelvic abscess requiring drainage), and one patient (0.8%) experienced a grade 4 complication (postoperative CVA). In the XI cohort eight patients (9.9%) experienced a grade 1 complication and one patient experienced a grade 3 complication (1.2%) (pelvic abscess requiring drainage). Discussion Robotic surgery for urologic conditions continues to evolve at a rapid rate with advancements focusing on primarily reducing morbidity. The newest iteration of the surgical system being adopted alongside the standard XI multi-port platform is the SP robot. The SP has its advantages in a single surgical docking arm and single laparoscopic trocar through which the camera and instruments articulate. With a shared paradigm of offering patients the most minimally invasive approach to treat their cancer, several centers have begun reporting their initial experiences for RALRP with the DaVinci SP. In order to drive more widespread adoption of the next generation of a system that already produces excellent outcomes, there must be a strong argument favoring its value added. Lenfant et al performed a cost comparison between the SP and Xi systems and demonstrated economic viability of the SP robot for RALRP, showing that although the cost for surgical consumables was higher for the SP cases, this was offset by lower cost from reduced hospital stay [ 4 ] . Importantly, many centers have reported favorable outcomes in their initial experience of SP RALRP in a limited series of cases [ 5 – 9 ] . These authors report similar ranges of procedures times, hospital stay, and incidence of complications to those that we report. However, this is one of the first reports of perioperative outcomes between the SP and Xi RALRP performed by a single surgeon. The retrospective study design precludes randomization therefore includes both measured and unmeasured confounding. We attempted to control for this as best as possible by only including results from a single surgeon at our high-volume center. Additionally, we included contemporaneous cohorts in order to avoid possible confounding from evolving management of prostate cancer over time. Our analysis showed no difference in procedure time, EBL, node count, margin status, Clavien complications or length of stay. This provides more evidence to a growing body of literature that SP RALRP is comparable to XI RALRP in terms of short-term postoperative outcomes. Combined, these data show that SP RALRP is not only accessible to urologists competent on the XI system, but that perioperative and pathologic outcomes are the same. Our study does have some limitations however. For instance, we did not compare pain scores between the two cohorts. Vigneswaran et al showed that patients undergoing SP RALRP had decreased pain on postoperative day 1 [ 5 ] . Similarly, Noël et al. reported higher scores on the Surgical Satisfaction Questionnaire (SSQ-8) in patients who underwent SP prostatectomy than those who underwent surgery with the Xi system [ 11 ] . Although both groups had high satisfaction scores overall, a main contributor to better satisfaction in the SP group was the better pain control and decreased number of surgical scars. We also did not stratify between intraperitoneal vs. extraperitoneal, and nerve sparing vs. non nerve sparing. Although the vast majority of the RALRPs that performed at our center are intraperitoneal and nerve sparing, further head-to-head investigation is needed as others have reported on the safety and efficacy of extraperitoneal SP RALRP [ 12 ] . Additionally, our lymph node yield was somewhat lower than other reports though evidence suggests that higher lymph node yields during RALRP are not impactful on rate of biochemical recurrence [ 14 ] . Further research is also needed to better characterize the learning curve of the SP platform that is present with any new surgical technique. In the future, we hope to analyze and compare long term functional outcomes such as urinary incontinence and erectile dysfunction between the two systems. Conclusions We conducted one of the largest studies to date comparing perioperative variables for robotic assisted laparoscopic prostatectomy performed by a single surgeon on the DaVinci SP and Xi platforms. There were no statistically significant differences seen between perioperative or pathological outcomes between the two groups. Likewise, there were no differences in complications between the two groups. Furthermore, as a function of time, there was not a meaningful trend seen in SP operative variables. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALRPs through a single incision without compromising patient outcomes. Declarations Ethical approval - Erlanger Institutional Review Board approved this study Competing interests – none Author contributions SSR – data analysis, manuscript preparation AAS – data collection, assistance with manuscript preparation MJW – data analysis, manuscript preparation AS – manuscript preparation, primary surgeon Funding: none Availability of data and materials – not publicly available References Van Koughnett JA, Jayaraman S, Eagleson R, Quan D, Van Wynsberghe A, Schlachta CM. Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon’s perspective? J Robot Surg. 2009;3(2). Estes SJ, Goldenberg D, Winder JS, Juza RM, Lyn-Sue JR. Best practices for robotic surgery programs. J Soc Laparoendosc Surg. 2017;21(2). Ng, C.-F., Teoh, J.Y.-C., Chiu, P.K.-F., Yee, C.-H., Chan, C.-K., Hou, S.S.-M., Kaouk, J. and Chan, E.S.-Y., Robot-assisted single-port radical prostatectomy: A phase 1 clinical study. Int. J. Urol. 2019. 26: 878-883. Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J. Single-institution Cost Comparison: Single-port Versus Multiport Robotic Prostatectomy. Eur Urol Focus. 2021;7(3). Vigneswaran HT, Schwarzman LS, Francavilla S, Abern MR, Crivellaro S. A Comparison of Perioperative Outcomes Between Single-port and Multiport Robot-assisted Laparoscopic Prostatectomy. Eur Urol. 2020;77(6). Dobbs RW, Halgrimson WR, Madueke I, Vigneswaran HT, Wilson JO, Crivellaro S. Single-port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci® SP platform. BJU Int. 2019;124(6). Kaouk J, Bertolo R, Eltemamy M, Garisto J. Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System. Urology. 2019 Feb 1;124:309. Ju GQ, Wang ZJ, Shi JZ, Zhang ZQ, Wu ZJ, Yin L, et al. A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System. Asian J Androl. 2021;23(6). Agarwal DK, Sharma V, Toussi A, Viers BR, Tollefson MK, Gettman MT, et al. Initial Experience with da Vinci Single-port Robot-assisted Radical Prostatectomies. Eur Urol. 2020;77(3). Lenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J. Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int. 2021;128(6). Noël J, Moschovas MC, Sandri M, Bhat S, Rogers T, Reddy S, et al. Patient surgical satisfaction after da Vinci® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis. J Robot Surg. 2022;16(2). Kaouk J, Valero R, Sawczyn G, Garisto J. Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique. BJU Int. 2020 Jan;125(1):182-189. Dindo D, Demartines N, Clavien PA. Classifications of surgical complications. Annals of Surgery. 2004 Aug; 240(2): 205–213. Badani KK, Reddy BN, Moskowitz EJ, Paulucci DJ, Beksac AT, Martini A, Whalen MJ, Skarecky DW, Huynh LM, Ahlering TE. Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesical invasion and node-negative disease. Urol Oncol. 2018. Jun;36(6):310.e1-310.e6. Dobbs RW, Halgrimson WR, Talamini S, Vigneswaran HT, Wilson JO, Crivellaro S. Single- port robotic surgery: the next generation of minimally invasive surgery. World J Urol. 2020 Apr;38(4):897-905. Tables Table 1- Patient Characteristics SP RALP (n=127) XI RALP (n=81) p-value Age (mean ± SD) 65 ± 7 66 ± 7 0.60 BMI (mean ± SD) 29.2 ± 5.1 30.1 ± 4.9 0.22 Race White Black Other 105 (83.3) 15 (11.9) 6 (4.8) 61 (75.3) 14 (17.3) 6 (7.5) 0.37 ASA Class, n (%) =3 40 (31.5) 87 (68.5) 29 (35.8) 52 (64.2) 0.52 Median PSA (ng/ml) [IQR] 7.1 [5.5, 10] 7.4 [5.5,10] 0.94 Prostate volume (cc ± SD ) 46.1 ± 25.3 47.5 ± 20.7 0.69 D’Amico Risk Score n(%) Low Intermediate High 7 (5.6) 91 (72.8) 27 (21.6) 4 (4.9) 47 (58.0) 30 (37.0) 0.053 Table 2 – Perioperative Outcomes SP RALP (n=127) XI RALP (n=81) p-value Median OR time, min [IQR] 170 [156,187] 168 [138,195] 0.35 Median EBL, mL [IQR] 100 [25,200] 100 [50,300] 0.14 Median LOS, days [range] 1 [1,13] 1 [0,10] 0.22 Clavien Complication None 1 2 3 4 113 (89.0) 12 (9.5) 0 (0) 1 (0.8) 1 (0.8) 72 (88.9) 8 (9.9) 0 (0) 1 (1.2) 0 (0) 0.99 Table 3 – Pathologic Outcomes SP RALP (n=127) XI RALP (n=81) p-value ISUP grade group, n (%) 1 2 3 4 5 7 (5.5) 55 (43.3) 44 (34.7) 1 (0.8) 20 (15.8) 5 (6.3) 22 (27.5) 27 (33.8) 5 (6.3) 21 (26.3) 0.025 T Stage pT2 pT3a pT3b 61 (48.0) 55 (43.3) 11 (8.7) 33 (41.3) 40 (50.0) 7 (8.8) 0.61 Positive surgical margin 38 (29.9) 24 (29.6) 0.96 Median no.lymph nodes removed [IQR] 3 [2,5] 3 [2,5] 0.94 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Sep, 2023 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Major revision 03 Sep, 2023 Reviews received at journal 23 Aug, 2023 Reviewers agreed at journal 28 Jul, 2023 Reviewers invited by journal 28 Jul, 2023 Editor assigned by journal 16 Jul, 2023 Submission checks completed at journal 13 Jul, 2023 First submitted to journal 06 Jul, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3146651","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":218329963,"identity":"6fccff7f-f5c8-44d9-a485-decd60eb1687","order_by":0,"name":"Samit Sunny Roy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYFAD9gYGhgekaeE5wMCQQJoWiQQitcjPyD32mIfhnpzBzcfHPiTU3LHrlz7A+LjiF24tBjfy0o15GIqNDW6nJc9IOPYseWZfArPh2T48WiRyzKR5GBISN9zOMWZIYDucbHCGgU2ysQefw2Babp7/zJDw73CyPSEtDDdgWm7wMDMkth22M+ABamn4gcdhZ96YSc4xSDCWPJNmzJDYdzhB4gxjs2FjAx6HteeYSbypSJDjO374McOHb4ft+XuYDz5s+IPHYUDAxGPAwKBwAMJJbGBgBKI2/FoYQQ6XhzrFHkIRsGUUjIJRMApGFAAAeFZQ8lTzZbQAAAAASUVORK5CYII=","orcid":"","institution":"University of Tennessee at Chattanooga","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Samit","middleName":"Sunny","lastName":"Roy","suffix":""},{"id":218329965,"identity":"92d83e9f-ba20-4628-a159-1d6db8f8abd8","order_by":1,"name":"Aditya A. Sathe","email":"","orcid":"","institution":"University of Tennessee Health Science Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aditya","middleName":"A.","lastName":"Sathe","suffix":""},{"id":218329967,"identity":"1f619b30-31d8-4bbf-a798-35e670a9cfa8","order_by":2,"name":"Matthew J. Watson","email":"","orcid":"","institution":"University of Tennessee at Chattanooga","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"J.","lastName":"Watson","suffix":""},{"id":218329968,"identity":"8094ce84-3882-4615-b4fd-b1fbe5759d64","order_by":3,"name":"Amar Singh","email":"","orcid":"","institution":"Erlanger Health System","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amar","middleName":"","lastName":"Singh","suffix":""}],"badges":[],"createdAt":"2023-07-06 16:14:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3146651/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3146651/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-023-01720-w","type":"published","date":"2023-09-22T15:01:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":43640559,"identity":"b6a7c692-b179-4377-893f-b7ade74deaff","added_by":"auto","created_at":"2023-09-25 15:07:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":215786,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3146651/v1/238991a0-643d-4283-99e9-67e7be1f540f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Robotic Assisted Laparoscopic Radical Prostatectomy: SP versus XI, a Single Surgeon Experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRobotic Assisted Laparoscopic Radical Prostatectomy (RALRP) is the current standard for the treatment of clinically significant prostate cancer (CSPCa). The minimally invasive approach offers patients excellent results with respect to postoperative recovery and cosmesis while granting the surgeon increased dexterity and visualization\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Currently, the DaVinci surgical system (Intuitive Surgical; Sunnyvale, CA) is the leading platform for robotic urologic surgery and is FDA-approved since the early 2000s. Robotic surgery confers increased benefits in reducing morbidity and improving patient satisfaction, but is associated with a significant level of investment both in the purchasing and regular maintenance of the system in its life cycle\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Furthermore, with each iteration of the technology, there exists a need for a head-to-head comparison with older models to determine any added value for patients, physicians, and hospital systems. If a new platform cannot be proven to provide at least as good of outcomes as an older generation, then its widespread adoption should not occur. In 2018, a model now known as the Davinci Single-Port (SP) received FDA approval for urologic procedures\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The SP system relies on just a single surgical incision to deliver multiple articulating tools into the body. Initial case reports from small series have deemed the DaVinci SP to show promise in terms of safety and efficacy\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. However, there is currently a paucity of data directly comparing RALRP outcomes between the SP system and its predecessor, the DaVinci Xi. Our objective was to analyze SP RALRP outcomes and compare them to Xi outcomes at a single tertiary care academic medical center using a single-surgeon control to avoid possible inter-surgeon bias.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAll patients had biopsy confirmed CSPCa, defined as Gleason grade group 2 or higher. All underwent RALRP with curative intent. All surgeries were performed by a single surgeon (AS) at a tertiary care academic center in the United States. The cohort included 127 consecutive SP cases performed from December 2018 to April 2021, which represents the time frame from which the SP platform began being used at our institution for RALRP. Likewise, 81 consecutive XI cases from March 2018 \u0026ndash; April 2021 were selected for comparison. The dates of the comparison XI cohort were selected in order to compare a contemporaneous cohort of XI RALRP patients in order to obtain a real-world comparison given the widespread adoption of the XI platform. Patients with previous prostate cancer therapies were excluded (e.g. brachytherapy, radiation, cryoablation). Preoperative patient variables included mean age, race, average BMI, PSA, ISUP Gleason grade group, ASA score dichotomized as \u0026le;2 or \u0026ge;3, and prostate volume (as assessed on preoperative prostate MRI or CT where MRI unavailable). Perioperative outcomes of interest included procedure time, length of stay, final estimated blood loss (EBL), length of stay (LOS), incidence of complications and histopathologic data. Procedure time was recorded as time from incision to completion of closure. Complications were assessed with the Clavien-Dindo classification system\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Histopathological data included grade group, tumor stage, positive surgical margins, and node yield.. All pathology slides were reviewed by the same pathologist who specializes in GU pathology. Variables were analyzed using STATA statistical software, version 16 (StataCorp. 2019 College Station, TX). Chi-square, Fisher\u0026rsquo;s exact test, paired t-tests, and Wilcoxon rank sum tests were used where appropriate.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were no statistically significant differences between the SP and XI cohorts in terms of mean age (65 vs 66 years; p\u0026thinsp;=\u0026thinsp;0.60), BMI (29.2 vs 30.1 kg/m\u003csup\u003e2;\u003c/sup\u003e p\u0026thinsp;=\u0026thinsp;0.22) ASA score \u0026ge;3 (68.5% vs 64.2%; p\u0026thinsp;=\u0026thinsp;0.53), or prostate volume (46.1 g v 47.5 g, p\u0026thinsp;=\u0026thinsp;0.69). There was a trend towards a higher D\u0026rsquo;Amico risk score among patients undergoing XI RALP (37.0%) as compared to SP RALP (21.6%) though this failed to achieve statistical significance (p\u0026thinsp;=\u0026thinsp;0.053) [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]. There was no difference in the median procedure time (170 v 168 min, p\u0026thinsp;=\u0026thinsp;0.35), median EBL (100 v 100 ml, p\u0026thinsp;=\u0026thinsp;0.14), or median LOS (1 vs 1 day p\u0026thinsp;=\u0026thinsp;0.22) [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]. On histopathological analysis we found that XI RALP was significantly more likely to be performed on higher grade group disease (p\u0026thinsp;=\u0026thinsp;0.025). There was no significant difference in pathological tumor stage (p\u0026thinsp;=\u0026thinsp;0.61), positive surgical margins (29.9% vs 29.6%; p\u0026thinsp;=\u0026thinsp;0.96), or median number of lymph nodes removed (3 vs 3 nodes; p\u0026thinsp;=\u0026thinsp;0.94) between the two cohorts [Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]. There was no difference between the groups with Clavien complications (p\u0026thinsp;=\u0026thinsp;0.99), with 89% of patients in both groups experiencing no complications. In the SP cohort twelve patients (9.5%) experienced a grade 1 complication, one patient (0.8%) experienced a grade 3 complication (pelvic abscess requiring drainage), and one patient (0.8%) experienced a grade 4 complication (postoperative CVA). In the XI cohort eight patients (9.9%) experienced a grade 1 complication and one patient experienced a grade 3 complication (1.2%) (pelvic abscess requiring drainage).\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eRobotic surgery for urologic conditions continues to evolve at a rapid rate with advancements focusing on primarily reducing morbidity. The newest iteration of the surgical system being adopted alongside the standard XI multi-port platform is the SP robot. The SP has its advantages in a single surgical docking arm and single laparoscopic trocar through which the camera and instruments articulate. With a shared paradigm of offering patients the most minimally invasive approach to treat their cancer, several centers have begun reporting their initial experiences for RALRP with the DaVinci SP. In order to drive more widespread adoption of the next generation of a system that already produces excellent outcomes, there must be a strong argument favoring its value added. Lenfant et al performed a cost comparison between the SP and Xi systems and demonstrated economic viability of the SP robot for RALRP, showing that although the cost for surgical consumables was higher for the SP cases, this was offset by lower cost from reduced hospital stay\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Importantly, many centers have reported favorable outcomes in their initial experience of SP RALRP in a limited series of cases\u003csup\u003e[\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. These authors report similar ranges of procedures times, hospital stay, and incidence of complications to those that we report. However, this is one of the first reports of perioperative outcomes between the SP and Xi RALRP performed by a single surgeon. The retrospective study design precludes randomization therefore includes both measured and unmeasured confounding. We attempted to control for this as best as possible by only including results from a single surgeon at our high-volume center. Additionally, we included contemporaneous cohorts in order to avoid possible confounding from evolving management of prostate cancer over time. Our analysis showed no difference in procedure time, EBL, node count, margin status, Clavien complications or length of stay. This provides more evidence to a growing body of literature that SP RALRP is comparable to XI RALRP in terms of short-term postoperative outcomes. Combined, these data show that SP RALRP is not only accessible to urologists competent on the XI system, but that perioperative and pathologic outcomes are the same.\u003c/p\u003e \u003cp\u003eOur study does have some limitations however. For instance, we did not compare pain scores between the two cohorts. Vigneswaran et al showed that patients undergoing SP RALRP had decreased pain on postoperative day 1\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Similarly, No\u0026euml;l et al. reported higher scores on the Surgical Satisfaction Questionnaire (SSQ-8) in patients who underwent SP prostatectomy than those who underwent surgery with the Xi system \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Although both groups had high satisfaction scores overall, a main contributor to better satisfaction in the SP group was the better pain control and decreased number of surgical scars. We also did not stratify between intraperitoneal vs. extraperitoneal, and nerve sparing vs. non nerve sparing. Although the vast majority of the RALRPs that performed at our center are intraperitoneal and nerve sparing, further head-to-head investigation is needed as others have reported on the safety and efficacy of extraperitoneal SP RALRP\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Additionally, our lymph node yield was somewhat lower than other reports though evidence suggests that higher lymph node yields during RALRP are not impactful on rate of biochemical recurrence\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Further research is also needed to better characterize the learning curve of the SP platform that is present with any new surgical technique. In the future, we hope to analyze and compare long term functional outcomes such as urinary incontinence and erectile dysfunction between the two systems.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe conducted one of the largest studies to date comparing perioperative variables for robotic assisted laparoscopic prostatectomy performed by a single surgeon on the DaVinci SP and Xi platforms. There were no statistically significant differences seen between perioperative or pathological outcomes between the two groups. Likewise, there were no differences in complications between the two groups. Furthermore, as a function of time, there was not a meaningful trend seen in SP operative variables. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALRPs through a single incision without compromising patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e- Erlanger Institutional Review Board approved this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026ndash;\u0026nbsp;\u003c/strong\u003enone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003cbr\u003e\u0026nbsp;SSR\u0026nbsp;\u003c/strong\u003e\u0026ndash; data analysis, manuscript preparation\u003cbr\u003e\u003cstrong\u003eAAS\u003c/strong\u003e \u0026ndash; data collection, assistance with manuscript preparation\u003cbr\u003e\u003cstrong\u003eMJW\u003c/strong\u003e \u0026ndash; data analysis, manuscript preparation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAS\u003c/strong\u003e \u0026ndash; manuscript preparation, primary surgeon\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003enone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u0026ndash;\u0026nbsp;\u003c/strong\u003enot publicly available\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVan Koughnett JA, Jayaraman S, Eagleson R, Quan D, Van Wynsberghe A, Schlachta CM. Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon\u0026rsquo;s perspective? J Robot Surg. 2009;3(2). \u003c/li\u003e\n\u003cli\u003eEstes SJ, Goldenberg D, Winder JS, Juza RM, Lyn-Sue JR. Best practices for robotic surgery programs. J Soc Laparoendosc Surg. 2017;21(2). \u003c/li\u003e\n\u003cli\u003eNg, C.-F., Teoh, J.Y.-C., Chiu, P.K.-F., Yee, C.-H., Chan, C.-K., Hou, S.S.-M., Kaouk, J. and Chan, E.S.-Y., Robot-assisted single-port radical prostatectomy: A phase 1 clinical study. Int. J. Urol. 2019. 26: 878-883.\u003c/li\u003e\n\u003cli\u003eLenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J. Single-institution Cost Comparison: Single-port Versus Multiport Robotic Prostatectomy. Eur Urol Focus. 2021;7(3).\u003c/li\u003e\n\u003cli\u003eVigneswaran HT, Schwarzman LS, Francavilla S, Abern MR, Crivellaro S. A Comparison of Perioperative Outcomes Between Single-port and Multiport Robot-assisted Laparoscopic Prostatectomy. Eur Urol. 2020;77(6). \u003c/li\u003e\n\u003cli\u003eDobbs RW, Halgrimson WR, Madueke I, Vigneswaran HT, Wilson JO, Crivellaro S. Single-port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci\u0026reg; SP platform. BJU Int. 2019;124(6). \u003c/li\u003e\n\u003cli\u003eKaouk J, Bertolo R, Eltemamy M, Garisto J. Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System. Urology. 2019 Feb 1;124:309. \u003c/li\u003e\n\u003cli\u003eJu GQ, Wang ZJ, Shi JZ, Zhang ZQ, Wu ZJ, Yin L, et al. A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System. Asian J Androl. 2021;23(6). \u003c/li\u003e\n\u003cli\u003eAgarwal DK, Sharma V, Toussi A, Viers BR, Tollefson MK, Gettman MT, et al. Initial Experience with da Vinci Single-port Robot-assisted Radical Prostatectomies. Eur Urol. 2020;77(3). \u003c/li\u003e\n\u003cli\u003eLenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J. Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int. 2021;128(6). \u003c/li\u003e\n\u003cli\u003eNo\u0026euml;l J, Moschovas MC, Sandri M, Bhat S, Rogers T, Reddy S, et al. Patient surgical satisfaction after da Vinci\u0026reg; single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis. J Robot Surg. 2022;16(2). \u003c/li\u003e\n\u003cli\u003eKaouk J, Valero R, Sawczyn G, Garisto J. Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique. BJU Int. 2020 Jan;125(1):182-189. \u003c/li\u003e\n\u003cli\u003eDindo D, Demartines N, Clavien PA. Classifications of surgical complications. Annals of Surgery. 2004 Aug; 240(2): 205\u0026ndash;213.\u003c/li\u003e\n\u003cli\u003eBadani KK, Reddy BN, Moskowitz EJ, Paulucci DJ, Beksac AT, Martini A, Whalen MJ, Skarecky DW, Huynh LM, Ahlering TE. Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesical invasion and node-negative disease. Urol Oncol. 2018. Jun;36(6):310.e1-310.e6. \u003c/li\u003e\n\u003cli\u003eDobbs RW, Halgrimson WR, Talamini S, Vigneswaran HT, Wilson JO, Crivellaro S. Single- port robotic surgery: the next generation of minimally invasive surgery. World J Urol. 2020 Apr;38(4):897-905. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1- Patient Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003eSP RALP (n=127)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003eXI RALP (n=81)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eAge (mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e65\u0026nbsp;\u0026plusmn;\u0026nbsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e66\u0026nbsp;\u0026plusmn;\u0026nbsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eBMI (mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e29.2\u0026nbsp;\u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e30.1\u0026nbsp;\u0026plusmn; 4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105 (83.3)\u003c/p\u003e\n \u003cp\u003e15 (11.9)\u003c/p\u003e\n \u003cp\u003e6 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61 (75.3)\u003c/p\u003e\n \u003cp\u003e14 (17.3)\u003c/p\u003e\n \u003cp\u003e6 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eASA Class, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026lt;=2\u003c/p\u003e\n \u003cp\u003e\u0026gt;=3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (31.5)\u003c/p\u003e\n \u003cp\u003e87 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (35.8)\u003c/p\u003e\n \u003cp\u003e52 (64.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eMedian PSA (ng/ml) [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e7.1 [5.5, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e7.4 [5.5,10]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eProstate volume (cc\u0026nbsp;\u0026plusmn; SD\u0026nbsp;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e46.1\u0026nbsp;\u0026plusmn; 25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e47.5\u0026nbsp;\u0026plusmn; 20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\" style=\"width: 39.1178%;\"\u003e\n \u003cp\u003eD\u0026rsquo;Amico Risk Score n(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Low\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Intermediate\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\" style=\"width: 24.043%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (5.6)\u003c/p\u003e\n \u003cp\u003e91 (72.8)\u003c/p\u003e\n \u003cp\u003e27 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\" style=\"width: 27.332%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (4.9)\u003c/p\u003e\n \u003cp\u003e47 (58.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;30 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 \u0026ndash; Perioperative Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eSP RALP (n=127)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003eXI RALP (n=81)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eMedian OR time, min [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e170 [156,187]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e168 [138,195]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eMedian EBL, mL [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e100 [25,200]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e100 [50,300]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eMedian LOS, days [range]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e1 [1,13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e1 [0,10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eClavien Complication\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e113 (89.0)\u003c/p\u003e\n \u003cp\u003e12 (9.5)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72 (88.9)\u003c/p\u003e\n \u003cp\u003e8 (9.9)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e1 (1.2)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u0026ndash; Pathologic Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eSP RALP (n=127)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003eXI RALP (n=81)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eISUP grade group, n (%)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (5.5)\u003c/p\u003e\n \u003cp\u003e55 (43.3)\u003c/p\u003e\n \u003cp\u003e44 (34.7)\u003c/p\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003cp\u003e20 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (6.3)\u003c/p\u003e\n \u003cp\u003e22 (27.5)\u003c/p\u003e\n \u003cp\u003e27 (33.8)\u003c/p\u003e\n \u003cp\u003e5 (6.3)\u003c/p\u003e\n \u003cp\u003e21 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eT Stage\u003c/p\u003e\n \u003cp\u003epT2\u003c/p\u003e\n \u003cp\u003epT3a\u003c/p\u003e\n \u003cp\u003epT3b\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61 (48.0)\u003c/p\u003e\n \u003cp\u003e55 (43.3)\u003c/p\u003e\n \u003cp\u003e11 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (41.3)\u003c/p\u003e\n \u003cp\u003e40 (50.0)\u003c/p\u003e\n \u003cp\u003e7 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePositive surgical margin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e38 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e24 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003eMedian no.lymph nodes removed [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e3 [2,5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.38461538461539%\" valign=\"top\"\u003e\n \u003cp\u003e3 [2,5]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3146651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3146651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e \u003cp\u003eCurrently there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to compare our single-institution single-surgeon SP RALP experience to our XI RALP experience with regards to patient selection, perioperative data, and outcomes.\u003c/p\u003e \u003cp\u003eMethods\u003c/p\u003e \u003cp\u003ePatients who underwent prostatectomy at our institution between August 2019 to April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one urologist at our institution to limit inter-surgeon variability. Demographic and clinical information were extracted from the medical record in standardized fashion. All documented classifications were graded using the Clavien-Dindo classification system. Patients with previous prostate cancer therapies were excluded. Categorical variables were compared using Chi-square or Fisher\u0026rsquo;s exact test where appropriate. Continuous variables were compared using t-tests or Wilcoxon rank sum tests where appropriate.\u003c/p\u003e \u003cp\u003eResults:\u003c/p\u003e \u003cp\u003eComplete records were available for 208 patients. Of the total patient population 127 (61.1%) underwent SP prostatectomy compared to 81 (38.9%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65 vs. 66 years; p\u0026thinsp;=\u0026thinsp;0.60), BMI (29.2 vs 30.1; p\u0026thinsp;=\u0026thinsp;0.22), preop ASA score\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3 (68.5% vs. 64.2%; p\u0026thinsp;=\u0026thinsp;0.52), or preop PSA (7.1 vs. 7.4, p\u0026thinsp;=\u0026thinsp;0.94). There no difference in procedure time for SP prostatectomy (170 vs. 168 min, p\u0026thinsp;=\u0026thinsp;0.035), estimated blood loss (100 vs. 100 mL; p\u0026thinsp;=\u0026thinsp;0.14), or average length of stay (1 vs. 1 days; p\u0026thinsp;=\u0026thinsp;0.22). There was a significant difference in Gleason grade group between the two cohorts with patients undergoing XI RALRP more likely to have higher stage disease (p\u0026thinsp;=\u0026thinsp;0.025) and a trend towards higher D\u0026rsquo;Amico risk scores in the XI group (p\u0026thinsp;=\u0026thinsp;0.053). There was no difference in rate of positive surgical margins (29.9% vs. 29.6%; p\u0026thinsp;=\u0026thinsp;0.96). There was no difference in the distribution of complications between the two groups (p\u0026thinsp;=\u0026thinsp;0.99) with 89% of patients having no complication. There was no difference in the number of lymph nodes removed by modality (p\u0026thinsp;=\u0026thinsp;0.94).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: To date, this study represents one of the largest cohorts of patients who underwent SP RALP. Importantly, it is among the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to minimal differences in patient factors, perioperative results, or outcomes between the platforms. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e","manuscriptTitle":"Comparison of Robotic Assisted Laparoscopic Radical Prostatectomy: SP versus XI, a Single Surgeon Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-18 08:44:37","doi":"10.21203/rs.3.rs-3146651/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-09-03T14:33:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-08-23T20:02:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"722abc68-c50f-4f15-9540-481b0f195173","date":"2023-07-28T20:35:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-07-28T04:18:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-07-16T18:55:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-07-13T13:42:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2023-07-06T16:04:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4063e742-a3c1-4920-adef-98686b69d378","owner":[],"postedDate":"July 18th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-25T15:04:48+00:00","versionOfRecord":{"articleIdentity":"rs-3146651","link":"https://doi.org/10.1007/s11701-023-01720-w","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2023-09-22 15:01:42","publishedOnDateReadable":"September 22nd, 2023"},"versionCreatedAt":"2023-07-18 08:44:37","video":"","vorDoi":"10.1007/s11701-023-01720-w","vorDoiUrl":"https://doi.org/10.1007/s11701-023-01720-w","workflowStages":[]},"version":"v1","identity":"rs-3146651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3146651","identity":"rs-3146651","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}