PROSTATE SURGERY
The da Vinci Single Port robot –
faster recovery than before
Keyhole prostate cancer surgery has transformed the operation of radical prostatectomy from the traditional ‘open’ operation that was associated with a 20% complication rate, a 30% risk of blood transfusion and a prolonged recovery into an operation that is more precise, safer and quicker to recover from, thanks to better instrumentation, a clearer view of the operation (due to magnification and less bleeding) and smaller incisions in the patient’s abdomen.
This improvement was achieved initially by laparoscopic surgery in the 2000s, in which the surgeon holds the instruments in his hands, and then by robot-assisted surgery in the 2010s, which led to even better cancer control and preservation of bladder and sexual function.
The next step in this evolution is the da Vinci Single Port (SP) platform, which allows all 4 robotic arms to be introduced into the patient through a single small incision (or ‘port’) below the belly button, compared to the need for 4 separate abdominal incisions for conventional ‘multiport’ robotic surgery.
da Vinci ‘multiport’ robotic surgery
Intuitive Surgical’s first da Vinci robot, consisting of a surgical console, a vision cart and a patient cart, was first introduced into operating theatres in 2000. Since then, more than 11 million robotic surgeries have been performed worldwide using 7,500 systems, which have evolved in sophistication and ease of use from the early ‘standard model’ 3-arm robot, through the 4-arm S and Si models to the latest Xi and 5 systems.
The medical literature, which including hundreds of clinical studies, bears testament to the numerous advantages of robotic surgery for prostatectomy:-
- less blood loss
- lower complication rate
- reduced post-operative pain, earlier discharge from hospital and shorter convalescence
- better cancer control
- better preservation of bladder and sexual function
The da Vinci Single Port robotic platform
The main advantage of the SP robotic system is that it further reduces post-operative patient discomfort and so accelerates recovery by requiring fewer incisions to be made in the abdomen. It works by having 4 arms that separate from the central column when deployed, each of which is flexible and has two articulating joints. One arm carries the the telescopic camera through which the surgeon views a high-definition 3-D image, and the other three arms are for surgical instruments which can be changed. As well as each arm being capable of a large range of movement, the whole column on which they are mounted 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.
You can view the da Vinci SP system in more detail, including with a video, by clicking the button below.
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, which 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, which reduces bleeding-related complications but also appears to significantly improve potency preservation following prostatectomy with a 1- year post-surgery potency rate in non-diabetic previously-potent men <70 years age of 78.1 % https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2021.0128
- the da Vinci Single Port platform.
Our recent data in over 400 cases has shown that not only does Retzius-sparing robotic prostatectomy allow most (90%) men to undergo radical prostatectomy with no incontinence but there also seems to be a trend to significantly better potency (erections), without any detriment to cancer control, which is a significant improvement over the traditional robotic technique.
Urinary continence outcome for Retzius-sparing prostatectomy