Abstract
Minimally invasive surgery continues to evolve to reduce the surgical and anesthetic burden for patients. We present the first prospective pilot case series to assess the feasibility and safety of combining extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) with neuraxial anesthesia and intraoperative virtual reality (VR) support. Ten consecutive patients with low-risk prostate cancer underwent SP-RARP under combined spinal-epidural anesthesia and immersive VR distraction offered by the HypnoVR device to enhance patient comfort and reduce anxiety during surgery. Dedicated questionnaires focused on intraoperative HypnoVR tolerability and the patient experience. Data for perioperative parameters and anxiety trends were collected. All procedures were successfully completed without conversion to general anesthesia. Hemodynamic stability was maintained, with only two transient hypotensive episodes managed pharmacologically. Median operative time was 90 min and median hospital stay was 2 d, with no intraoperative or postoperative complications. Pain scores remained negligible (Visual Analog Scale 0/10) and no involuntary movements were reported. Nine patients (90%) completed surgery wearing the HypnoVR visor; most reported better comfort and lower anxiety. State-Trait Anxiety Inventory scores significantly decreased from before surgery to the 24-h postoperative assessment, and Health-Information Technology Usability Evaluation Scale scores confirmed high usability. The study demonstrates that SP-RARP under neuraxial anesthesia combined with VR is safe, feasible, and well accepted, and supports further investigation to validate the impact of this approach on recovery and patient-centered outcomes.