How to cite: Slawin JR. How has the SP robot affected our approach to radical prostatectomy? September 19, 2025. Accessed December 2025. https://grandroundsinurology.com/how-has-the-sp-robot-affected-our-approach-to-radical-prostatectomy-3/
Summary
Jeremy R. Slawin, MD, MBA, Director of Urologic Robotic Surgery, Baylor College of Medicine, Houston, Texas, discusses how single-port (SP) robotic platforms are redefining the surgical approach to radical prostatectomy. He explains how SP systems enable direct extraperitoneal and transvesical access, reduce perioperative morbidity, and support same-day discharge without compromising oncologic or functional outcomes.
Dr. Slawin describes the transition from traditional multiport robotic prostatectomy to SP techniques that restore the advantages of extraperitoneal access once used in open surgery. The SP platform allows all instruments to pass through a single cannula, enabling direct entry into the space of Retzius while maintaining a minimally invasive approach. This design eliminates the need for wide port spacing and reduces dependence on the peritoneal cavity, potentially benefiting patients with prior abdominal surgery or adhesions.
Dr. Slawin outlines the SP procedural steps and emphasizes key technical adjustments, including supine positioning without a steep Trendelenburg position, the use of a floating dock for instrument articulation, lower insufflation pressures (8–10 mmHg) to avoid venous gas emboli, and reliance on flexible or remote-operated suction. Challenges include reduced instrument strength, limited retraction, and a smaller working space. However, Dr. Slawin notes that the learning curve is modest, typically plateauing after 30–40 cases.
Comparative data from multi-institutional and propensity-matched studies show SP extraperitoneal prostatectomy results in slightly longer operative times and lower lymph node yields but less postoperative pain, decreased opioid use, fewer ileus events, and shorter hospital stays. Costs appear equivalent to those of multiport systems, as a reduced length of stay offsets higher disposable costs.
Dr. Slawin argues that the SP robot enables surgeons to perform extraperitoneal procedures on extraperitoneal glands, thereby improving recovery and maintaining comparable oncologic and functional outcomes.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Jeremy Slawin, MD, MBA, is an Assistant Professor of Urology at Baylor College of Medicine in Houston, Texas and a staff surgeon at the Michael E. DeBakey VA Medical Center in Houston, Texas. Dr. Slawin earned his MD from Baylor College of Medicine and his MBA from Rice University. Dr. Slawin completed a fellowship in robotic surgery and urologic oncology at Houston Methodist Hospital. Dr. Slawin completed his residency in urology at the NYU Grossman School of Medicine at Langone Medical Center at Bellevue Hospital and at the Manhattan VA Hospital in New York City, New York.
