Robot-assisted simple prostatectomy: the evolution of a surgical technique

Abstract

_______________________________________________________________________________________Purpose: Enucleation of a large prostate is the best surgical choice for patients refractory to clinical treatment (1, 2). Since the first robot-assisted simple prostatectomy (RASP) was described (3, 4), some technical modifications (5-7) and different approaches to reach the adenoma have been proposed (8,9). The aim of this video is to demonstrate three different techniques of RASP. Materials and Methods: The first procedure begins with a transversal incision over the bladder neck, the second is a transvesical approach and the last one is a Retzius-sparing RASP. All techniques were performed with a vesico-urethral anastomosis.Results: Three patients underwent RASP, each one with a different approach. Patients presented mean age of 66±4.4 years, PSA baseline level of 7.8±3ng/mL, IPSS score of 17.7±4.5, maximum urine flow of 8.3±1.5mL/seg and 122.3±11.2cm3 of prostate volume. The mean operative time was 63±8 minutes, estimated blood loss of 106.7±11.5mL, prostate weight of the surgical specimen of 106.3±8 grams and 1 day of length of stay. No continuous bladder irrigation was required and there was no complication. The mean postoperative PSA and IPSS were 0.7±0.3ng/mL, 4.7±1.5. The maximum urine flow raised to 20±4.4mL/seg. Conclusions: RASP with vesico-urethral anastomosis allowed minimal blood loss, short length of stay and great functional outcomes. All the three approaches allowed to perform this technique in a safe way, while showing different alternatives to reach the adenoma.

Perioperative Outcome of Thulium Laser Enucleation of the Prostate versus Robot-Assisted Simple Prostatectomy: A Propensity Score-Matched Analysis

“…The reason for the longer catheterization time is the bladder incision which is given a couple of days to heal before catheter removal. As a technical modification, vesico-urethral anastomosis has been shown to have the potential to decrease the risk of bleeding and reduce catheterization time in RASP [20,21]; only small case series have been published, however. Looking at complications, no difference was observed in either CDC or CCI.…”

Prostatachirurgie beim benignen Prostatasyndrom >200 ml: Endoskopisch, robotisch oder doch offen?

“…Bei sehr großen Prostatavolumina vermindern sich diese Vorteile der AEEP offenbar [11]. Technische Weiterentwicklungen wie die Anastomisierung von Harnröhre und Blasenhals reduzieren die postoperative Blutungsneigung und führen zu weniger postoperativer Dysurie [19,20,21]. Die urethraerhaltende RAE, für die aktuell noch begrenzte Daten vorliegen, ist eine anspruchsvolle und innovative Technik, die zusätzlich die antegrade Ejakulation erhalten kann [22,23].…”