Single-Port extraperitoneal robotic-assisted radical prostatectomy in a patient with preexisting artificial urinary sphincter: First clinical experience

Robotic-assisted radical prostatectomy in patients with a history artificial urinary sphincter (AUS) placement has not been previously described. We describe the technique of extraperitoneal single-port robotic-assisted radical prostatectomy in a patient with a preexisting functional AUS, with emphasis on critical technical details of the procedure to prevent injury to the AUS components. The patient was a 69-year-old male with history of total urinary incontinence after transurethral resection of the prostate managed with AUS placement in 2011. He was diagnosed with multifocal intermediate risk Gleason 3 + 4 prostate cancer and scheduled for robotic assisted radical prostatectomy (RARP) with bilateral pelvic lymph node dissection (PLND). Extraperitoneal robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissection were performed with a pure single-site approach using the da Vinci SP® surgical system. There were no intraoperative complications. There was no damage to the adjacent organs or the AUS components. Operative time was 180 min with negligible blood loss. The Foley catheter was removed on postoperative day 7 and the AUS was reactivated afterwards. Patient could void without any difficulty and was pad free when AUS was active. Histopathological examination of the specimen showed prostate adenocarcinoma with Gleason score 3 + 4 disease and unilateral extra prostatic extension (pT3a) with focally positive margins. Three-month postoperative nadir prostate specific antigen (PSA) was undetectable and the patient remained pad-free during the same period. Extra-peritoneal robotic-assisted RP in a patient with preexisting AUS by using a single-port robotic platform is safe and feasible. When compared to multi-port robotic instrumentation, the single-port robotic arms enter from the same incision, which may result in decreased out-of-field instrument contact with the AUS hardware.