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

Rodrigues, Gilberto J.; Sawczyn, Guilherme V.; Guglielmetti, Giuliano B.; Fazoli, Arnaldo J. C.; Tanure, Luís H. R.; Nahas, William C.; Coelho, Rafael F.

doi:10.1590/S1677-5538.IBJU.2020.0744

ABSTRACT

Purpose:

Enucleation of a large prostate is the best surgical choice for patients refractory to clinical treatment (¹1. Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines 2020. [Internet]. Available at. <https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/>
https://uroweb.org/guideline/treatment-o... ,²2. Cimen, H. I., Atik, Y. T., Gul, D., Uysal, B., & Balbay, M. D. (2019). Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes. International braz j urol : official journal of the Brazilian Society of Urology, 45, 1122–8.). Since the first robot-assisted simple prostatectomy (RASP) was described (³3. Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R. Robotic simple prostatectomy. J Urol. 2008;179:513-5.,⁴4. Qi F, Wang S, Xu H, Gao Y, Cheng G, Hua L. A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution. Int Braz J Urol. 2019; 45:695-702.), some technical modifications (⁵5. Coelho RF, Chauhan S, Sivaraman A, Palmer KJ, Orvieto MA, Rocco B, et at. Modified technique of robotic-assisted simple prostatectomy: advantages of a vesico-urethral anastomosis. BJU Int. 2012; 109:426-33.–⁷7. Evren I, Hacıislamoglu A, Eksi M, Yavuzsan AH, Baytekin F, Çolakoglu Y, et at. The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy. Int Braz J Urol. 2019; 45:45-53.) and different approaches to reach the adenoma have been proposed (⁸8. Cockrell R, Bonzo J, Lee D. Robot-Assisted Simple Prostatectomy. J Endourol. 2018; 32(S1):S33-S38.,⁹9. De Concilio B, Silvestri T, Justich M, Vedovo F, Zeccolini G, Celia A. A Novel Technique for Robotic Simple Prostatectomy: An Evolution of Retzius-sparing Technique. Urology. 2018; 115:185.). 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.

REFERENCES

¹
Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines 2020. [Internet]. Available at. <https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/>
» https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/
²
Cimen, H. I., Atik, Y. T., Gul, D., Uysal, B., & Balbay, M. D. (2019). Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes. International braz j urol : official journal of the Brazilian Society of Urology, 45, 1122–8.
³
Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R. Robotic simple prostatectomy. J Urol. 2008;179:513-5.
⁴
Qi F, Wang S, Xu H, Gao Y, Cheng G, Hua L. A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution. Int Braz J Urol. 2019; 45:695-702.
⁵
Coelho RF, Chauhan S, Sivaraman A, Palmer KJ, Orvieto MA, Rocco B, et at. Modified technique of robotic-assisted simple prostatectomy: advantages of a vesico-urethral anastomosis. BJU Int. 2012; 109:426-33.
⁶
Neumaier MF, Segall CH Júnior, Hisano M, Rocha FET, Arap S, Arap MA. Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy. Int Braz J Urol. 2019; 45:703-12.
⁷
Evren I, Hacıislamoglu A, Eksi M, Yavuzsan AH, Baytekin F, Çolakoglu Y, et at. The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy. Int Braz J Urol. 2019; 45:45-53.
⁸
Cockrell R, Bonzo J, Lee D. Robot-Assisted Simple Prostatectomy. J Endourol. 2018; 32(S1):S33-S38.
⁹
De Concilio B, Silvestri T, Justich M, Vedovo F, Zeccolini G, Celia A. A Novel Technique for Robotic Simple Prostatectomy: An Evolution of Retzius-sparing Technique. Urology. 2018; 115:185.

Publication Dates

Publication in this collection
29 Mar 2021
Date of issue
May-Jun 2021

History

Received
17 Aug 2020
Accepted
26 Aug 2020
Published
20 Dec 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines 2020. [Internet]. Available at. <https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/>
» https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/

[2] ²
Cimen, H. I., Atik, Y. T., Gul, D., Uysal, B., & Balbay, M. D. (2019). Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes. International braz j urol : official journal of the Brazilian Society of Urology, 45, 1122–8.

[3] ³
Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R. Robotic simple prostatectomy. J Urol. 2008;179:513-5.

[4] ⁴
Qi F, Wang S, Xu H, Gao Y, Cheng G, Hua L. A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution. Int Braz J Urol. 2019; 45:695-702.

[5] ⁵
Coelho RF, Chauhan S, Sivaraman A, Palmer KJ, Orvieto MA, Rocco B, et at. Modified technique of robotic-assisted simple prostatectomy: advantages of a vesico-urethral anastomosis. BJU Int. 2012; 109:426-33.

[6] ⁶
Neumaier MF, Segall CH Júnior, Hisano M, Rocha FET, Arap S, Arap MA. Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy. Int Braz J Urol. 2019; 45:703-12.

[7] ⁷
Evren I, Hacıislamoglu A, Eksi M, Yavuzsan AH, Baytekin F, Çolakoglu Y, et at. The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy. Int Braz J Urol. 2019; 45:45-53.

[8] ⁸
Cockrell R, Bonzo J, Lee D. Robot-Assisted Simple Prostatectomy. J Endourol. 2018; 32(S1):S33-S38.

[9] ⁹
De Concilio B, Silvestri T, Justich M, Vedovo F, Zeccolini G, Celia A. A Novel Technique for Robotic Simple Prostatectomy: An Evolution of Retzius-sparing Technique. Urology. 2018; 115:185.

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