Magnetic-assisted Robotic Surgery to Facilitate Reduced-port Radical Prostatectomy

BACKGROUND: Tissue retraction during minimally-invasive urologic surgery currently is achieved by either gravity via patient positioning or placement of additional ports for robotic arms or bedside assistant instrumentation. A novel magnetic retractor system (Levita Magnetic Surgical System, San Mateo, CA) was recently approved by the Food and Drug Administration for use in minimally invasive surgery. OBJECTIVE: To evaluate the safety and efficacy of magnetic-assisted robotic surgery (MARS) to perform a reduced-port radical prostatectomy (RP). MATERIALS: Sixteen patients underwent a MARS reduced-port RP in the treatment of prostatic adenocarcinoma at a single institution from June 2018 to September 2018 utilizing the magnetic retraction device in lieu of the 4th robotic arm for tissue retraction. All surgical procedures were completed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA). The magnetic retractor was used to manipulate and retract the colon, peritoneum, seminal vesicles, prostatic capsule during neurovascular bundle dissection, and bladder during lymphadenectomy. RESULTS: All cases were successfully completed without placement of a 4th robotic arm or an additional assistant port. The magnetic retractor subjectively provided comparable retraction and exposure to these tools. No intraoperative or immediate postoperative complications were noted. Mean operative time was 236 ± 23 minutes and mean blood loss was 265 ± 88 mL. All patients were discharged to home by postoperative day 2. CONCLUSION: Magnetic-assisted reduced-port robotic prostatectomy is a novel technique that appears to be both safe and effective. Use of the magnetic system avoids the need for a 4th robotic arm, potentially minimizing the morbidity of surgery and improving cosmesis. Further, none of the fundamental steps of the procedure were changed or compromised. Outcomes analysis in larger cohorts and cost analysis is warranted.