Multi incision vs one incision da Vinci RP - benefits & risks

Posted by tjp1958 @tjp1958, Jul 1 6:08pm

I am faced with RARP and have researched Single port/incision versus multiport/incision RARP. Single port appears to have quicker recovery and less side effects from an ED, UI point of view. Does anyone have experience with this? Any input, data, experience is appreciated.

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Profile picture for rlpostrp @rlpostrp

Well…those of us who had radical prostatectomy, chose one or the other method, so a comparison is not possible. But…my urologist told me that he only does the single-incision DaVinci robotic method. I don’t know what is better, especially for post-op recovery, nor if 5 smaller 1/2” holes are better than the one 2.5” to 3” single incision. I just know that I was lulled into thinking the DaVinci robotic single incision would be better...a breeze per my urologist. I was very wrong. My surgery was mid-April, and the first two weeks were pretty bad with pain (needed 10 mg Percocet); the constipation due to the narcotic-based Percocet; and the feeling that I had been assaulted, pummeled, and beat down below my navel. It was very deep pain…scary deep that stops you in your tracks. Your pelvic floor muscles take the brunt of the surgery. That along with losing two of your three urinary sphincters with the resulting urinary incontinence made it miserable. It was bad enough, plus the exasperating incontinence, that I regret having the surgery. My dad lived to with two months of age 100 years. My maternal grandfather lived to 96; and my maternal uncle lived to 86…all with prostate cancer that never saw them have the prostatectomy. They all died of something else. Maybe I would have enjoyed the same longevity.

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I am so sorry to hear that : (((. You are completely right, people will have different experience and different opinions based on their own experience.
We can only rely on statistics and make sure that we choose the best surgeons that had thousands of cases done with great success, but recovery is very case dependent and very individual matter.

As you said , we can not choose multiple ways and compare them, so we will never know if our particular choice was the best one for us personally. It all can go either way for any choice in life, we just can do our best making reasonable decision with the best chances of success. All the rest is written in the stars and in our genes.

On the side note, just for the reference - were you treated by surgeon that specialize in prostate cancer and works in Cancer Center of Excellence and who is doing hundreds of those surgeries every year and has about at least 15 years of experience behind him ?
Also, was you cancer contained in a prostate or they found it has spread to local areas and had to remove additional tissue and nodes ? If surgery turned out to be more extensive and they removed nerve bundles and similar, recovery definitely can be more lengthy and more painful. : (((

Wishing you much faster recovery from this point on < 3 and may the cancer be gone !!!

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My neurovascular bundle(s) were preserved per the urologist/surgeon’s report. I was one of the unlucky 10-20% that have “surgical margins.” I also had minimal invasion into the left seminal vesicle, but my urologist said he was taking both of my seminal vesicles and both vas deferens before he even knew there was invasion in that left seminal vesicle. I also had “cribiform glands” identified (apparently not good). No tumor or extensive cells were found in the left seminal vesicle. All cells were grade “3”. My biopsy Gleason of 3+4 =7 only had 10% “4” cells, but all of the above changed when the left seminal vesicle invasion was identified, as minimal as it was. I am classified a p3Tb which, for whatever reason tends to experience a fairly high recurrence rate at 5 years, despite no remaining prostate. I’ll know more in my next follow up at the end of July, to include what I hope is a PSA if < 0.1.

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I had multi and can't say I had any problems. I believe single would be more old school. Very small incisions and pain free a few hours after surgery exception being the main one going through the bottom of the navel. Felt gut shot there for a week or so. Had to barrel roll out of bed for 1.5 weeks. I guess if you have a choice you have options. I wouldn't change facilities over that one. I had no urinary related problems. Might be one of those things to not over think. Good luck and get er done.

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Having had a couple of abdominal surgeries including a multiport partial nephrectomy last July and after meeting with several surgeons from a couple centers of excellence, I choose a single port radical transvesical (through the bladder) prostatectomy at a center of excellence in April. Pain was mild and recovery was faster than with the nephrectomy. Post surgical pathology was encouraging and first PSA undetectable. Only downside thus far has been rather significant and unexpected incontinence albeit have experienced major improvement the past several weeks. So, for me, I have no regrets whatsoever with going single port and would make the same choice again.
Do your homework, talk with highly experienced surgeons from both camps (multi vs. single) and make the decision which feels right for you.
All the best with your journey!

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