(1) Background:Since the introduction of the purpose-built Single Port (SP) robotic platform, there has been an ongoing debate regarding its advantages compared to the established multi-port (MP) system. The goal of this present study is to compare the perioperative, oncological, and functional outcomes of SP Extraperitoneal robotic radical prostatectomy (RARP) versus that of MP Transperitoneal RARP approach at a high-volume tertiary center.(2) Methods:Based on a retrospective review of the prospectively maintained IRB-approved database, 925 patients successfully underwent RARP by a single experienced robotic surgeon. A 4:1 propensity-matched analysis based on the baseline prostate cancer International Society of Urological Pathology (ISUP) Grade Group, clinical stage, and preoperative Prostate Specific Antigen (PSA) was performed, which yielded a cohort of 606 patients—485 in the SP EP and 121 in the MP TP approaches. Of note, the SP EP approach also included the traditional Extraperitoneal (n = 259, 53.4%) and the novel Transvesical (TV) approaches (n = 226, 46.6%).(3) Results:The overall operative time was slightly longer in the SP cohort, with a mean of 198.9 min compared to 181.5 min for the MP group (p< 0.001). There were no intraoperative complications with the MP approach and only one during the SP approach. The SP EP technique demonstrated significant benefits, encompassing reduced intraoperative blood loss (SP 125.1 vs. MP 215.9 mL), shorter length of hospital stay (SP 12.6 vs. MP 31.9 h), reduced opioid use at the time of discharge (SP 14.4% vs. MP 85.1%), and an earlier Foley catheter removal (SP 6 vs. MP 8 days). From an oncological perspective, the rate of positive surgical margins remained comparable across both groups (p= 0.84). Regarding functional outcomes, the mean continence rates and Sexual Health Inventory for Men (SHIM) scores were identical between the two groups at 6 weeks, 3 months, and 6 months respectively.(4) Conclusion:SP EP RARP demonstrates similar performance to MP TP RARP in terms of oncologic and functional outcomes. However, SP EP RARP offers several advantages in reducing the overall hospital stay, decreasing postoperative pain and hence the overall opioid use, as well as shortening the time to catheter removal, all of which translates to reduced morbidity and facilitates the transition to outpatient surgery.
（1）背景：自专用单孔（SP）机器人平台问世以来，关于其相较于成熟多孔（MP）系统的优势一直存在争议。本研究旨在比较高容量三级医疗中心中SP经腹膜外机器人辅助根治性前列腺切除术（RARP）与MP经腹腔RARP的围手术期、肿瘤学及功能结局。 （2）方法：基于对前瞻性维护且经机构审查委员会批准数据库的回顾性分析，925例患者由同一位经验丰富的机器人外科医生成功实施RARP。根据基线前列腺癌国际泌尿病理学会（ISUP）分级分组、临床分期及术前前列腺特异性抗原（PSA）进行4:1倾向评分匹配分析，最终纳入606例患者——其中SP经腹膜外组485例，MP经腹腔组121例。需特别说明的是，SP经腹膜外组同时包含传统经腹膜外入路（n=259，53.4%）与新型经膀胱入路（n=226，46.6%）。 （3）结果：SP组总体手术时间略长（平均198.9分钟 vs MP组181.5分钟，p<0.001）。MP组未发生术中并发症，SP组仅出现1例。SP经腹膜外技术展现出显著优势：术中失血量更少（SP 125.1 mL vs MP 215.9 mL）、住院时间更短（SP 12.6小时 vs MP 31.9小时）、出院时阿片类药物使用率更低（SP 14.4% vs MP 85.1%）、导尿管拔除时间更早（SP 6天 vs MP 8天）。肿瘤学方面，两组手术切缘阳性率相当（p=0.84）。功能结局方面，术后6周、3个月及6个月的尿控恢复率与男性性健康量表（SHIM）评分在两组间均无统计学差异。 （4）结论：在肿瘤学与功能结局方面，SP经腹膜外RARP与MP经腹腔RARP表现相当。但SP经腹膜外RARP在缩短住院时间、减轻术后疼痛（从而降低阿片类药物总使用量）以及加速导尿管拔除方面具有多重优势，这些均有助于降低并发症发生率，并推动向门诊手术模式的转型。
肿瘤(癌症)患者之家