PROSTATE SURGERY
The da Vinci Single Port robot –
faster recovery than before
Keyhole surgery has transformed radical prostatectomy from the traditional ‘open’ operation associated with a 20% complication rate, a 30% risk of blood transfusion, and prolonged recovery into a safer, more precise procedure. With the advanced instrumentation of the da Vinci SP robot, surgeons achieve enhanced visualisation, reduced bleeding, and smaller incisions for better outcomes.
This improvement began with laparoscopic surgery in the 2000s, where surgeons manually controlled the instruments, followed by robot-assisted surgery in the 2010s, which provided improved cancer control and better preservation of bladder and sexual function.
The next step in this evolution is the da Vinci Single Port (SP) robotic prostatectomy. Unlike conventional multiport robotic surgery, which requires six separate abdominal incisions (four for the robot and two for the assistant), the SP system introduces all four robotic arms and an assistant port through a single small incision, or ‘port,’ located below the belly button.
da Vinci ‘multiport’ robotic surgery
Introduced in 2000, Intuitive Surgical’s first da Vinci robot revolutionised operating theatres with its surgical console, vision cart and patient cart. Since then, more than 11 million robotic surgeries have been performed worldwide using 7,500 systems. These systems have evolved in sophistication and ease of use, from the original 3-arm robot standard model, to the advanced 4-arm S and Si models, and now to the latest Xi and 5 systems.
Extensive medical evidence highlights the benefits of robotic prostatectomy
- minimally invasive techniques result in less blood loss
- enhanced precision leads to a lower complication rate
- smaller incisions reduce post-operative pain and speed up recovery
- precise removal of cancerous tissue improves cancer control
- delicate nerves are preserved, maintaining bladder and sexual function
The da Vinci Single Port robotic platform
The main advantage of a single port robotic prostatectomy is its ability to further reduce post-operative discomfort and accelerate recovery by requiring fewer abdomen incisions. The Da Vinci SP system features four arms that separate from the central column when deployed, each of which is flexible and has two articulating joints.
One arm holds the telescopic camera, providing the surgeon with a high-definition 3-D image, while the other three arms are equipped with interchangeable surgical instruments. Each arm is capable of a large range of movement, and the entire column can rotate, offering an unparalleled range of camera and instrument movement.
The da Vinci SP platform was awarded European medical device certification in December 2023 and we became the third European centre to adopt the SP robotic platform in April 2024.
What does the SP platform add to Retzius-sparing robotic prostatectomy?
The robotic SP platform adds a fourth key component to what I consider to be the optimal combination of technologies for obtaining the best cancer control, continence and potency results following prostatectomy in the current era:
- the Retzius-sparing technique, produces early post-operative continence that is 3x better than conventional robotic prostatectomy;
- using real-time frozen-section analysis of the prostate during the operation to allow the surgeon to optimise both cancer control and functional results (through more complete nerve preservation) rather than having to chose between the two, which is the case if this information is not available during surgery.
- the use of Arista, a topical haemostatic powder, at the end of the procedure helps reduce bleeding-related complications and appears to significantly improve potency preservation following prostatectomy. In non-diabetic men under 70 who were previously potent, the one-year post-surgery potency rate is 78.1%.
- the da Vinci Single Port platform allows the entire procedure to be performed transvesically (through the bladder), combining the enhanced continence preservation of Retzius-sparing surgery with an extraperitoneal approach. This method minimises bowel disturbance and is safer for patients with previously-operated abdomens.
Recent data from over 400 cases shows that Retzius-sparing robotic prostatectomy not only allows 90% of men to undergo the procedure without incontinence, but also appears to result in significantly better potency (erections), with no negative impact on cancer control. This represents a major improvement over traditional robotic techniques.
Urinary continence outcome for Retzius-sparing prostatectomy
