New technology brings a battle of the bots to center stage

Experts debate the top tool between single-port versus multi-port robotic prostatectomy.

Jeffrey Cadeddu, MD, and Jihad Kaouk, MD, FACS, FRCS
Jeffrey Cadeddu, MD, and Jihad Kaouk, MD, FACS, FRCS

For years, multi-port was the gold standard for robot-assisted prostatectomy. However, about three years ago a new challenger emerged in the form of a single-port device, raising the question: Which one will best serve you and your patients?

That question will be at the center of “Battle of the Robots: Which Is Superior? Single-Port vs. Multi-Port Robotic Prostatectomy” at 10:35 a.m. on Friday, May 13. During this session, Jihad Kaouk, MD, FACS, FRCS, professor of surgery and director of the Center for Robotic and Image Guided Surgery at the Cleveland Clinic’s Lerner College of Medicine, and Jeffrey Cadeddu, MD, director of the UT Southwestern Clinical Center for Minimally Invasive Treatment of Urologic Cancer at UT Southwestern Medical Center in Dallas, Texas, will present arguments debating the top tool.

The multi-port system has been in use for about 20 years in various models and offers robust instrumentation that features articulated wrist technology, allowing the surgeon to mimic movements of the human arm and wrist. Even though the single-port system might have a few advantages, including less pain for the patient and the outcome being cosmetically more appealing because it only requires one incision, Dr. Cadeddu argues these things aren’t as important to a patient with cancer.

“Patients who have cancer do not prioritize cosmetics and even pain (from the procedure) as much as they prioritize the quality outcome of the operation,” he said. “They care that you do a good oncological operation and give them a good, functional outcome in terms of continence and potency. If you tell a patient that you can do better with multi-port, I would argue the patient would choose multi-port over single-port because those outcomes are more important to the patient.”

Dr. Kaouk, meanwhile, said he believes the advantages of the single-port system go beyond cosmetic.

“The single-port approach, with one midline incision, allows us to stay effectively in the extraperitoneal space, eliminating cuts that result in insufflation of the peritoneal cavity,” he said. “Recently, we developed the transvesical radical prostatectomy approach, which gives us a significantly shorter time to continence, minimizing the pads due to urine leakage.”

Ultimately, the doctors agree that both approaches are still valid and that the goal should be the best outcome for the patient.

“Surgery keeps evolving quickly,” Dr. Kaouk said. “If progress is not made, we will be falling behind. This is not about one vs. multiple incisions, nor is it about the single-port replacing the multi-port robot. This is limiting the surgery just to the area of the disease. This is getting the surgery back to the retroperitoneal space without violating the peritoneal cavity. The impact of robotic surgery shifted a lot of urologic surgery to transperitoneal, whereas the single-port impact will be mainly returning back to the gold standard extraperitoneal approaches.”

“There are surgeons who use the single-port robot, and then there are those who use both and some who only use the multi-port,” Dr. Cadeddu added. “Some people with benign disease actually do prioritize cosmetic outcomes, but people with cancer just want to have a good operation with good outcomes.”

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