Transvesical robot‐assisted simple prostatectomy with 360° circumferential reconstruction: step‐by‐step technique

Abstract

Our 360° reconstruction during RASP is feasible and safe. The aim of the technique is to minimize use of electrocautery and decrease the raw surface area on the prostate capsule. This technical modification could potentially lessen postoperative bleeding after RASP and therefore the need for continuous bladder irrigation. In addition, it could potentially lead to mitigation of burning and irritative postoperative symptoms. Longer follow-up and comparative studies of different RASP techniques are still needed.

Robotic-Assisted Simple Prostatectomy: A Systematic Review

“…All 26 case studies [ 3 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] included in the final analysis were non comparative case series with level 3 evidence. In nine comparative studies [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], outcomes of RASP were compared to outcomes of other minimally invasive modalities (OSP, HoLEP, ThuVEP) for the treatment of benign prostate hyperplasia (BPH).…”

“…They also concluded that an intrafascial technique does not require postoperative irrigation. Cacciamani et al [29] reported RASP with 360 • circumferential reconstruction and Wang et al [30] published "Urethra Sparing" RASP series based on "Madigan surgical technique" first described in 1990 by Dixon et al [47]. Recently, Simone et al [32] reported, "Urethra and ejaculation preserving RASP" by implementing near-infrared fluorescence imaging-guidance to Madigan technique.…”

Transversal approach via a bladder neck and prostate combined longitudinal incision versus standard approach of robotic-assisted radical prostatectomy for localized prostate cancer: a retrospective analysis

“…Two surgeons found L-RALP has the following advantages when they performed L-RALP: (1) It does not require the liberation of the bladder and the peri vesical space, and the operation is limited to the deep pelvic space around the prostate. The prostate could be completely resected within the fascia, and the integrity of the vascular and nerve bundles can be fully preserved, which could reduce the damage of radical prostatectomy as much as possible; (2) Intraoperative bleeding is reduced by suture ligation, avoiding the influence of thermal injury on long-term sexual function and urinary continence function; (3) The integrity of the puboprostatic ligament and pudendal artery is preserved; (4) A longitudinal incision is used to open the bladder to more easily expose the vas deferens and seminal vesicles, the separation steps of the bladder neck are reduced, and the damage to the detrusor muscle group is minimized; (5) The bladder neck is easy to identify and retain during the operation, which reduces the incidence of bladder neck contracture and ureteral orifice injury, shortening the indwelling time of the postoperative catheter [ 18 , 32 , 33 ]; (6) The anatomy of the L-RALP starts from the 6 o’clock position of the prostate because the Denonvillier fascia was thicker here, and it is easy to separate with scissors, which can completely preserve the outer fascia and NVB on both sides of the prostate; (7) A sub umbilical incision and 0° mirror can be used for the whole operation. At an extreme angle, a 30° mirror can be considered, or the observation hole mechanical arm raised to improve the field of vision.…”

Modified laparoscopic simple prostatectomy combined with temporary internal iliac arteries clamping and urethrocystoanastomosis for large-volume benign prostatic hyperplasia: evaluation of efficacy and safety

“…В 2016 году G. Cacciamani et al в своей статье изложили технику реконструкции шейки мочевого пузыря при выполнении аденомэктомии. При использовании робота «Da Vinci Surgical System» ("Intuitive Surgical, Inc.", Sunnyvale, CA, USA) им удалось фиксировать слизистую мочевого пузыря к уретре циркулярно, тем самым полностью укрыв ложе удалённой аденомы простаты [22]. В 2012 году R. Coelho et al описали технику выполнения роботизированной РПЭ, которая помимо стандартной техники включала некоторые технические модификации в отношении реконструктивной части вмешательства [23].…”