V02-07: Robot-assisted Simple Prostatectomy with Tunnel-Shaped Trigonization (RASP-TST) versus Standard RASP
To compare early outcomes of a reconstructive technical modification for robotic-assisted simple prostatectomy (RASP) with those of conventional trigonization approach.
In a prospective and random model, 20 men who underwent to BPH surgical treatment were allocated in two groups (RASP and TST-RASP). Demographic and preoperative data (including IPSS and Flowmetry scores) were collected. The procedures were carried-out using the Si da Vinci Robotic System (Intuitive Surgical). Through a five-trocars transperitoneal access, we perform a longitudinal incision of the bladder wall and prostate capsule and the removal of prostatic adenoma in both groups. Next, using a three-steps reconstructive technique, a 360 trigonization of the bladder mucosa was proposed in TST-RASP group (Tunnel-Shaped Trigonization) rather than classic trigonization (RASP group). The TST enrolls the advancement of a bladder mucosa flap until the prostatic urethra (first step) followed by a running suture between the advanced mucosa and prostatic capsule bilaterally (second step). At this point the prostate capsule should be totally isolated from the rest of the urinary tract. Finally, a tunnel conformation is achieved closing both sides of the capsule and bladder mucosa anteriorly (third step). Perioperative data including operative time (OT), hospital stay (HS) and need of bladder irrigation (CBI) were analyzed. The CBI was maintained until no hematuria could be detected. The urinary scores were re-assessed 3 months after the procedure and complications were rated using the Clavien-Dindo method. The follow-up was 3 months. For statistical comparisons, the student t-test, Mann-Whitney and x2 tests were conducted using R software (version 3.4.2).
A statistical significant difference was found in CBI (0.55 vs 1.7; p < 0.001) and HS (1.7 vs 2.7; p= 0.03) favoring TST-RASP. Also, a longer operative time was found in this last group (101min vs 88min; p=0.04). No differences are found in demographic data, preoperative and postoperative urinary function scores (IPSS and Flowmetry) as well as other perioperative features. Only mild complications (I e II) were reported in both groups and no cases of urethral stricture were identified.
The rational for hiding the prostatic capsule is to optimize patient recover since hematuria is the most related factor to hospital stay length. The presented data have demonstrated that TST may lead us to shorter periods of CBI and HS compared to the standard technique.