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Background: Early recovery of continence and potency after robotic-assisted laparoscopic prostatectomy (RALP) still remains a challenge., Objective: To assess the effect of our modified apical dissection and lateral prostatic fascia preservation (mod-RALP) technique on early functional outcomes., Design, Setting, and Participants: Among 2168 patients who underwent RALP between 2017 and 2019, 104 received a mod-RALP, and for the purposes of this study they were propensity score (PS) matched with a control group of conventional RALP cases based on preoperative and histological characteristics., Surgical Procedure: In the mod-RALP technique, significant dissection of the apical complex was avoided with maximized preservation of periurethral tissue around the urethral stump. Nerve sparing was also modified with intrafascial dissection inside of the lateral fascia, leaving the lateral tissue including the neurovascular bundle (NVB) untouched and covered., Measurements: The mod-RALP and conventional RALP groups were compared for continence and potency recovery at 1 and 6 wk postoperatively, as well as at 3, 6, and 12 mo. Kaplan-Meier curves and multivariate Cox regression models were used to identify survival estimations and their predictors., Results and Limitations: The mod-RALP technique resulted in faster continence (mean 46 vs 70 d) and potency (mean 74 vs 118 d, p <  0.05 for both) recovery. Functional recovery rates at postoperative follow-up were significantly higher in the mod-RALP group at all time points within the first 6 mo following surgery. Multivariate analyses revealed age, baseline functional status, surgical technique, and lymph node dissection as independent predictors of early functional recovery. This study is limited by its retrospective design and small size of the study groups., Conclusions: Our results with a modified technique intended to better preserve the apical complex and NVBs suggest earlier recovery of urinary continence and sexual function. These results should be tested with future randomized studies., Patient Summary: We report a modified approach to apical dissection and lateral prostatic fascia preservation in robotic-assisted laparoscopic prostatectomy that resulted in earlier continence and potency recovery as compared with our conventional technique., (Copyright © 2020. Published by Elsevier B.V.)

Background: Since the implementation of robotic surgery, the platforms have been updating constantly in terms of arm configuration, tool design, scope settings, and the number of trocars placed. The introduction of new robotic technology is challenging and requires studies followed by technique adaptions., Objective: This study aims to report a logical and technologically safe approach to the learning curve using the da Vinci single-port (SP) console and describes our robotic-assisted radical prostatectomy (RARP) technique step by step., Design, Setting, and Participants: A prospective study from 26 consecutive patients who underwent RARP with the da Vinci SP console from June to August 2019., Surgical Procedure: All surgeries were performed with a transperitoneal technique; one robotic trocar was placed above the umbilicus and one additional 12 mm trocar was placed in the right lower quadrant., Measurements: We described the step-by-step technique and reported the perioperative and pathological data. In addition, we considered the hospital length of stay and pain scale following surgery. Continuous variables were reported as median and interquartile ranges. Categorical variables were reported as frequencies and proportions., Result and Limitations: The total median operative time was 121 min, console time was 85 min, and blood loss was 50 ml. No complications were reported. In the final pathology, four patients had Gleason 6, 20 had Gleason 7, one had Gleason 8, and one had Gleason 9.Of the patients, 70% were ≤pT2 and 30% were ≥pT3a. Only 11% had positive surgical margins. This study is limited by the small number of patients and a short period of follow-up to evaluate functional and oncological outcomes of this new technology., Conclusions: RARP with the da Vinci SP is feasible and safe. Therefore, the step-by-step technique described in this study could be considered an option to perform radical prostatectomies. However, we still need better-designed studies to compare the outcomes with those of the multiport platform., Patient Summary: We reported our step-by-step technique describing a safe approach to robotic-assisted radical prostatectomy during the transition from the Xi to the da Vinci single-port robot., (Copyright © 2020. Published by Elsevier B.V.)