Abstract Introduction Performing robot-assisted radical prostatectomy (RARP) together with penile prosthesis implantation in a single surgical session offers the opportunity to achieve oncologic control and early functional recovery while avoiding a second procedure. This video presents a case of extraperitoneal single-port RARP with bilateral ilio-obturator lymphadenectomy and simultaneous three-piece inflatable penile prosthesis implantation, performed with the da Vinci SP® system, highlighting the technical nuances, safety, and short-term functional outcomes. Objective To describe the surgical technique and evaluate the feasibility, safety, and early functional and oncologic outcomes of simultaneous extraperitoneal single-port robot-assisted radical prostatectomy with bilateral pelvic lymph node dissection and three-component penile prosthesis implantation using the da Vinci SP® system. Methods A 61-year-old man with high-risk prostate adenocarcinoma (Gleason 9 5+4, PSA 12.6 ng/mL, cT3aN0M0) underwent extraperitoneal single-port RARP using the da Vinci SP® system. A 4 cm infraumbilical mini laparotomy was made to place an Alexis® retractor and access the Retzius space. After docking, the prostate and bilateral ilio-obturator lymph nodes were dissected. The bladder neck was divided, the vas deferens and seminal vesicles were excised, and the prostate was removed with wide margins. A watertight vesicourethral anastomosis was achieved using the Van Velthoven technique. Under the same anesthesia, a three-piece inflatable penile prosthesis was implanted through a separate scrotal incision under sterile conditions. Results Total operative time was 190 minutes, with an estimated blood loss of 300 mL. No intraoperative or postoperative complications occurred. Postoperative pain was mild (VAS=2), and the patient was discharged within 48 hours. Histopathological analysis revealed acinar prostate adenocarcinoma, Gleason 9 (5+4) – ISUP grade 5, with bilateral involvement and focal extraprostatic extension, as well as 20 lymph nodes, all negative for malignancy (pT3aN0).At 6 months of follow-up, PSA was undetectable, urinary continence was complete (0 pads), and the penile prosthesis was fully functional, with excellent patient satisfaction (PGI-I = 1, “very much better”). Conclusions Simultaneous extraperitoneal single-port robot-assisted radical prostatectomy with bilateral lymphadenectomy and penile prosthesis implantation using the da Vinci SP® system appears to be a safe and feasible approach in carefully selected patients. It provides effective oncologic control together with immediate sexual rehabilitation, helping to prevent penile shortening secondary to fibrosis, while reducing overall recovery time and surgical burden. Disclosure No
Otero et al. (Mon,) studied this question.
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