Robotic-assisted laparoscopic radical prostatectomy in a patient with sever Kyphoscoliosis, Ankylosing Spondylitis: a case report.

Abstract

Background: Anatomical abnormalities in kyphoscoliosis [KS] is a huge challenge in patient positioning for robotic prostatectomy. The narrow pelvis limits the range of movement of the robotic instruments' and port placing could be an issue. Second, carful preoperative assessment prior to administration of anesthesia and pneumoperitoneum in robot-assisted radical prostatectomy [RRP] is crucial to reduce peri-operative cardio-pulmonary complications.The Case: We report a successful use of robot in a patient with sever kyphoscoliosis for radical prostatectomy. He was a 58 years old male, overweight, with KS and history of cardiac stenting, bilateral total hip replacement. He had prostatic carcinoma. He is on antihypertensive medications, statins and bronchodilator inhalers. Auscultation revealed bronchovascular breathing with left base inspiratory crepitation. He was Mallampati score III [difficult intubation], recurrent chest infection, and severe restriction of respiratory function. The management had been performed under general anesthesia, in the supine-Trendelenburg-Lithotomy position before engaging the robot. The operative intervention showed stability of the patient except an episode of hypertension [an hour after starting surgery]. The total operative time [3 hours, 50 minutes]; the patient then transferred to intensive treatment unit for the next 12 hours. Postoperatively, backache is absent, drain removed 24 hours later; patient discharged after 48 hours, and catheter removed 10 days later. Histological examination showed adenocarcinoma of prostate, 35% of the gland with negative surgical margin. Conclusion:We confirmed that, robotic assisted radical prostatectomy could be handled in Kyphoscoliosis, Ankylosing Spondylitis with satisfactory outcome, irrespective of both technical and anaesthetic difficulties.

Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report

“…In a study by Kuwaijo and colleagues on a 58-year-old man with AS and severe kyphoscoliosis who was diagnosed with prostate carcinoma, the surgeons placed the patient under general anesthesia in the supine-Trendelenburg-Lithotomy position and performed the robot-assisted radical prostatectomy and this way they could overcome the complex state of the patient and the surgery was successful [ 19 ]. The second case was a 73-year-old man with AS and severe thoracolumbar kyphoscoliosis diagnosed with benign prostatic hyperplasia and was a candidate for transurethral resection of prostate under regional anesthesia; however, due to failure of epidural anesthesia because of spine deformity, and the team decided to use low-dose esketamine combined with sevoflurane inhalation to anesthetize patient to perform the intervention and they were successful [ 12 ].…”

“…However, simultaneous presence of AS and spine deformities like kyphoscoliosis is a relatively rare phenomenon reported in studies, with almost none of them targeted to repair the hip fusion [ 12 – 15 ]. In the rare case we present in this study, the patient was diagnosed with AS and severe kyphoscoliosis who was suffering from bilateral hip ankylosis that underwent single-stage bilateral hip fusion conversion to THA after spine surgery that corrected the kyphoscoliosis and let us to place the patient in supine position and perform conversion surgery in one session.…”