Feb. 10, 2024
Robotic-assisted prostatectomy has emerged as the leading approach for treating patients with prostate cancer, yet the procedures vary. While a multiport robotic approach involving 5 to 6 abdominal incisions is common in many hospitals, Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, uses a single-port robotic method.
"For clinically localized prostate cancer, a single-port procedure allows us to be much more focused on the prostate itself," says Matthew K. Tollefson, M.D., a urologist at Mayo Clinic in Rochester, Minnesota. "We're able to do very similar work to the multiport procedure with some unique benefits to each patient."
Specialists at Mayo Clinic participated in the early trials for the single-port robotic technology in 2018 and have continued studying the procedure. Dr. Tollefson and his team published their research in the June 2022 issue of Applied Ergonomics, measuring workload and learning curve for the single-port procedure compared with a multiport procedure.
"One of the biggest technical advantages to a single-port procedure is that we're able to get into a smaller space."
In the single-port technique, a solitary incision is made to insert all robotic tools. Surgeons direct these tools to diverge internally as they perform the surgery. The single-port prostatectomy, differing from its multiport counterpart, allows for both extraperitoneal and transvesical prostate removal methods.
"One of the biggest technical advantages to a single-port procedure is that we're able to get into a smaller space," says Dr. Tollesfon. "We can operate more precisely in the area each patient needs."
Overcoming workload difficulty: Perceptions change with experience
The single-port procedure is technically more difficult and puts higher demands on the surgical team. Surgeons and their surgical teams report higher physical and cognitive workload scores for single-port procedures compared to multiport procedures, which can put more teamwork demands on the care team.
The study team also evaluated how workload perceptions changed with more procedure experience. Mayo Clinic researchers found that surgeons' workload scores decreased after performing 25 single-port procedures, with a significant decrease observed after the first 5 to 10 operations.
Enhancing patient experience with single-port surgery and remote monitoring tools
Despite its complexity, the single-port method offers advantages for patients with prostate cancer. Fewer incisions provide the potential for less pain and shorter hospitalizations. In some cases, patients can be discharged on the same day as their procedures.
Mayo Clinic's innovative approach extends to post-operative care. Patients undergoing outpatient radical prostatectomy are enrolled in the MatCH (Monitoring at Charter House) program. This program offers patients accommodation in well-equipped guest apartments complete with remote monitoring tools rather than standard hospital rooms.
Patients enrolled in the MatCH program value the comforting environment and the peace of mind that comes with instant access to medical help when necessary. Patients can reach out to their healthcare providers at any moment. Additionally, for eligible patients, a one-night stay is provided at no cost.
"We're trying to be more proactive in handling post-operative care," says Dr. Tollefson. "We're able to do more for patients in recovery using the remote monitoring tools of the MatCH program."
For more information
Norasi H, et al. Intraoperative workload during robotic radical prostatectomy: Comparison between multi-port da Vinci Xi and single port da Vinci SP robots. Applied Ergonomics. 2022;104:103826.
Refer a patient to Mayo Clinic.