# Extraperitoneal Single-Port Robot-Assisted Radical Prostatectomy for a Massive Prostate: A Case Report

## TL;DR

This case report shows that a minimally invasive robotic prostate surgery can be successfully performed on a very large prostate using a specialized technique.

## Contribution

The paper demonstrates the first successful extraperitoneal SP-RARP for a prostate over 100 g, expanding the procedure's potential applications.

## Key findings

- A 143 g prostate was successfully removed using extraperitoneal SP-RARP with no intraoperative complications.
- The procedure was completed through a 4.5 cm incision with an estimated blood loss of 450 mL.
- The case supports the feasibility of SP-RARP for large prostates with proper technique.

## Abstract

Extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) using the da Vinci SP system (Intuitive Surgical, Sunnyvale, CA, US) offers a less invasive alternative to multi-port RARP. However, a significant limitation is the system’s reduced instrument force, which makes retraction and manipulation of large, heavy organs particularly challenging. As a result, SP-RARP for prostates over 100 g has been considered difficult and is rarely reported. This case highlights the feasibility of extraperitoneal SP-RARP in a patient with a massive prostate by addressing and overcoming this technical limitation.

We report the case of a 77-year-old man with bilateral ureteral stones, significant prostatic hypertrophy, and prostate adenocarcinoma (Gleason score 3+3), who underwent extraperitoneal SP-RARP due to urinary retention. The operation lasted 4 hours and 40 minutes, with an estimated blood loss of 450 mL through a 4.5 cm sub-umbilical incision. The prostate weighed 143 g. No intraoperative complications occurred, and the postoperative course was uneventful.

SP-RARP for massive prostates (>100 g) remains technically challenging due to the limited retraction force of the single-port system, and successful extraperitoneal cases have not been previously documented. This report demonstrates that, with proper technique, extraperitoneal SP-RARP can be safely and effectively performed even in cases involving significantly enlarged prostates. These findings support the potential expansion of SP-RARP indications in select high-volume cases.