Crivellaro, Simone

Introduction The introduction of the purpose‐built single‐port (SP) robotic platform has allowed for the advent of regionalized minimally invasive surgical approaches for robotic radical prostatectomy (RARP), including the extraperitoneal and transvesical techniques. This study sought to develop a best practice consensus on the key principles, patient selection, surgical techniques, expected clinical outcomes, and learning curves pertaining to SP‐RARP. Methods A modified Delphi consensus was developed by a panel of experts, consisting of a 33‐item questionnaire, with each statement rated using a binary Likert scale (‘agree’ or ‘disagree’). The survey was distributed via email to all practicing SP‐RARP surgeons across the USA and Europe. Consensus was defined as ≥75% agreement on a given statement. Results A total of 53 surgeons participated in the Delphi Consensus across the two rounds. Of 33 statements, 28 (84.8%) reached agreement in the first round. The remaining consensus was achieved in the second round, involving 35 surgeons, and with one additional statement. The panel agreed that, although are no absolute contraindications to SP‐RARP, the preference towards specific SP‐RARP techniques should remain guided by the individual patients and surgical expertise. Although the SP extraperitoneal technique is recommended to pursue pelvic lymph node dissections, the panel agreed that transvesical SP‐RARP showed promise in promoting shorter hospital stay, faster recovery of urinary continence, and utility in patients with extensive prior abdominal surgery. Consensus was also reached on the need for a structured training pathway, with most recommending beginning with extraperitoneal SP‐RARP before advancing to the transvesical approach. Conclusion This Delphi consensus demonstrates broad agreement among experienced SP surgeons in the USA and Europe, forming the foundation for future research on the clinical utility and necessary training pathways for SP‐RARP. Nevertheless, empirical validation based on clinical data from large cohort studies remains important.

Abstract Introduction and Objective This study aims to evaluate the learning curve and perioperative outcomes of single‐port extraperitoneal robotic radical prostatectomy (SP‐EP‐RARP) performed by a single surgeon at a high‐volume academic institution. Methods A retrospective review of a prospectively maintained database was conducted for patients who underwent SP‐EP‐RARP from September 2023 to August 2025. Key metrics included operative time, estimated blood loss, conversion rate, nerve‐sparing status, pathological margin status and continence (0–1 pad for safety), and 30‐day complication rate. Descriptive statistics were used, and outcomes were analysed chronologically to assess for trends suggesting a learning curve. Results The cohort included 53 patients who underwent extraperitoneal SP‐EP‐RARP. Median operative time was 213 min (IQR: 145–281). Median estimated blood loss was 100 mL (IQR: 75–125). Nerve‐sparing was attempted in 75.5% of cases. No assist or plus one ports were utilized. Final pathology revealed pT2 disease in 64.1% (34 cases), pT3a in 32.1% (17 cases) and pT3b in 3.7% (2 cases). Overall positive margin rate was 26.4%. Thirty‐day Clavien–Dindo Grades I–II complication rates were 11.3%, and no major complications or 90‐day complications were reported. Continence rates at 6 weeks, 3 months and 6 months were 72%, 72% and 75%, respectively. Stabilization of operative times and intraoperative outcomes occurred after approximately 25–30 cases. Conclusion SP‐EP‐RARP can be safely implemented by a newly graduated fellowship‐trained robotic surgeon with acceptable oncologic and functional outcomes. Initial learning can be estimated at approximately 25–30 cases.