AUA 2019: Single Port Radical Prostatectomy versus Xi Multi-Port Radical Prostatectomy - UroToday

Chicago, IL (UroToday.com) Robotic prostatectomy has become the de facto standard of care operation for prostate cancer, particularly in the United States. With multiple studies demonstrates improvement in estimated blood loss and post-operative recovery compared to open radical prostatectomy (albeit without any established oncologic benefit), robotic transperitoneal or extraperitoneal radical prostatectomy with the Intuitive DaVinci Si, X or Xi (Intuitive Surgical, Sunnyvale, CA) platform has become the predominant approach. 

However, more recently, Intuitive has introduced a new robotic platform, the single-port (SP) platform (Intuitive Surgical, Sunnyvale, CA). With double-jointed instruments being inserted through a larger single-port, new approaches can be considered – including single-port transperitoneal, extraperitoneal and even perineal. 

In this interesting study, the authors evaluate cognitive load during these two approaches. “Cognitive load” measures the number of informational elements that need to be processed to complete a given task. It has been previously shown that increases in overall cognitive load can result in stress, decreased efficiency, and ultimately suboptimal surgeon performance. To better understand the impact of this new SP technology, the authors compared the SP and Multi-port (MP) platforms through objective measurement of cognitive load during the crucial steps of a robotic-assisted laparoscopic prostatectomy (RALP).

They prospectively compared the first 10 SP-RALPs performed at their academic institution with 10 MP RALPs (between 12/2018 and January 2019), all performed by a single experienced robotic surgeon over the same period. Naturally, by comparing the first 10 SP-RALPs to 10 MP-RALPs that are much later in a surgeons’ experience introduces significant bias, and this should be kept in mind. All 20 procedures were completed by the same surgeon. 

Comparisons were made with respect to mental workload (NASA Task Load Index), surgical workload (Surgery Task Load Index), team work (Observational Teamwork Assessment for Surgery) and workflow disruptions. 

Interesting, the group found no statistically significant difference between the MP and SP platforms in the cognitive workload experienced by the surgeon during the performance of a RALP using the NASA Task Load Index, Surgery Task Load Index or Observational Teamwork Assessment analyses. Workflow disruptions were similar between the two cohorts. The total robotic console time did not significantly vary between the platforms.

Full results seen below:

Based on this, despite the 10 SP-RALPs being in the early experience of the surgeon and the MP-RALPs being much later in their experience, this single surgeon and his/her team appeared to have no significant issues transitioning to the SP platform. This suggests that in the hands of an experienced robotic surgeon the adaptation of this technology is feasible and attainable.

Presented by: Simone Crivellaro, MD, University of Illinois at Chicago, College of Medicine

Co-authors: Susan Talamini, Whitney Halgrimson, Ryan Dobbs, Chicago, IL

Written by: Thenappan Chandrasekar, MD (Clinical Instructor, Thomas Jefferson University) (twitter: @tchandra_uromd, @JEFFUrology) at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

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