Single-port robotics reduce incisions, may lead to less pain and quicker recovery from prostatectomy

Feb. 22, 2022

Matthew K. Tollefson, M.D., is a urologic oncologist and chair of the Robotics Subcommittee at Mayo Clinic in Rochester, Minnesota.

Tell us a little of the history of robotics at Mayo Clinic and how that has evolved?

Mayo Clinic has a long and storied history of robotic surgery. Matthew T. Gettman, M.D., performed some of the first robotic procedures in the world. Dr. Gettman, a urologist at Mayo Clinic in Minnesota, is currently assigned to Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates (UAE), a collaboration between Mayo Clinic and Abu Dhabi Health Services Company, the largest health care network in the UAE. His initial robotic procedures were performed in 2002 with the first-generation robot from Intuitive Surgical Inc. The number of patients treated since that time has grown exponentially. Mayo Clinic now treats more than 7,000 patients every year with procedures ranging from inguinal hernia repairs to open-heart surgery.

Technical advances in robotics have facilitated many of these clinical advances. The initial surgical robots possessed relatively rudimentary instruments with limited utility. Modern generations of surgical robots have advanced to include tools that have increased dexterity and allow additional technologies such as vessel sealing and stapling.

The most recent robotic development has been the single port (SP). With SP technology, the robotic instruments enter through a single channel and branch out inside that smaller incision. Compared with multiport robotics, the SP allows the surgery to be completed with fewer incisions on the abdomen — essentially making minimally invasive surgery even more minimally invasive.

When did you first perform SP prostatectomies and what was that process like?

We were fortunate to be among the first medical centers in the world to embrace SP technology. Our initial SP cases were performed in November 2018. Because the user interface is very different from multiport to SP surgery, those initial cases were preceded by several weeks of laboratory surgery to ensure we were performing the surgery safely. Early surgeries took slightly longer because we were learning the nuances of the SP robotics. However, as time has progressed, studies have shown that the learning curve is around 25 to 30 cases. Importantly, that learning curve exists for the entire surgical team and not just the operating surgeon.

What potential benefits may be provided by SP prostatectomy?

SP surgery has several specific advantages. Specifically, fewer incisions can lead to less pain and a quicker recovery from surgery. Also, many patients with prior abdominal surgery may be better candidates for SP than multiport surgery because the abdominal access can be made over a smaller area with fewer adhesions.

Are there other new techniques that have been made possible by SP prostatectomy?

SP radical prostatectomy really can mimic multiport surgery and complete all the techniques necessary. Though the area in which SP radical prostatectomy really shines is extraperitoneal surgery. Extraperitoneal prostatectomy, by necessity, is performed in a relatively small area, and clashing of instruments is common with multiport approaches. However, the SP robot is able to enter that smaller space, branch out and complete the procedure with less interference between the instrument arms.

Who is an ideal patient for SP prostatectomy?

Because of the smaller working space, it is more time intensive to perform extended lymphadenectomy. Therefore, in our experience, the ideal patient does not require extensive lymphadenectomy, preferably with low- or intermediate-grade prostate cancer.

Have you noticed any changes in patient outcomes with SP prostatectomy?

While there is a cosmetic advantage, many patients who receive radical prostatectomy are not as sensitive to those effects. Postoperatively, however, patients clearly have less abdominal pain, use smaller amounts of narcotics and stay in the hospital for a shorter time. In many ways, hospitalization after SP prostatectomy can reliably be measured in hours rather than overnights.

For more information

Refer a patient to Mayo Clinic.