Robot-assisted radical perineal prostatectomy: first experience of 15 cases

Abstract

Objective: Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot-assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP. Material and methods:Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT ® device was placed and robotic system was docked. Results:The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m 2 . Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients. Conclusion:We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area.

Robotic perineal radical prostatectomy in a patient with a pre-existing three piece inflatable penile prosthesis

“…But, he preferred surgical treatment and r-PRP was performed using a Da Vinci XI robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) as defined in our article on 15 patients (▶ Fig. 2) [2].…”

“…Robotic PRP (r-PRP) was first performed by Kaouk et al in a cadaver model and then in 4 living patients [1]. Then, we published our experience on 15 patients who underwent r-PRP [2].Today, penile prosthesis implantation is the gold standard treatment modality with high satisfaction and low complication rates for the medical treatment of refractory erectile dysfunction. It has two types: malleable and inflatable (2-piece, 3-piece).…”

Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy

“…As this technique is performed below the endopelvic fascia and bladder neck level, anatomy and physiology created by several prior surgeries such as kidney transplantation or intestinal bypass systems for colorectal cancer can be maintained. Tugcu et al performed this technique in 15 patients and reported that it can be safely performed in terms of oncological and functional outcomes (6). In this study, we aimed to investigate the effect of pelvimetric diameters measured preoperatively by multiparametric magnetic resonance imaging on peroperative findings and postoperative oncological outcomes.…”

Robotic perineal radical prostatectomy and robotic pelvic lymph node dissection via a perineal approach: The Tugcu Bakirkoy Technique

“…Kaouk et al [2,3] described the technique of robot-assisted radical perineal prostatectomy (r-RPP) model on cadavers and reported the results of first four patients. Tugcu et al [4] initially applied this technique to 15 patients and reported that this technique could be applied safely by presenting their results. Based on the results of the patients in the series, it was found that this method provides great advantages in patients with high body mass index, which was a major handicap for prior abdominal surgeries.…”