A novel peritoneal channel technique using a hemostatic agent to minimize symptomatic fluid collections after single-port robot-assisted radical prostatectomy.

Symptomatic fluid collections are a source of morbidity for patients after single-port (SP) robot assisted radical prostatectomy (RARP). We previously demonstrated a reduction in fluid collections by over 50% using peritoneal windows. This study represents the first reported use of a hemostatic agent to maintain peritoneal window patency, promoting wicking and reabsorption of postoperative fluid collections. The institution’s IRB-approved prostate cancer database was used to identify 467 patients who underwent extraperitoneal SP RARP by two surgeons from January 2021 to September 2025. Patients were stratified into cohorts based on surgical technique for prevention of postoperative fluid collection: (1) peritoneal window, (2) peritoneal window with Surgicel, and (3) neither (control). Symptomatic fluid collections were defined as having lower abdominal/pelvic pain, worsening urgency/frequency, or fever. Among 467 patients, symptomatic fluid collections were rare across groups. The Surgicel cohort (n = 77) had no symptomatic collections and no drainage procedures, compared to 10 symptomatic cases in the control group (n = 195) and 4 in the peritoneal window group (n = 195) (p = 0.005). Asymptomatic collections occurred in 3 patients from the Surgicel cohort (3.9%), none requiring intervention. We demonstrate a novel technique using hemostatic mesh to create a channel from the prostatectomy bed to the peritoneum after extraperitoneal SP RARP. This technique markedly reduced the incidence of symptomatic fluid collections and trends toward the reduction of overall collections. This technique is less complex and more time-efficient than the peritoneal window technique. Surgeons seeking to reduce the incidence of symptomatic fluid collections after extraperitoneal SP RARP should consider this technique.