V08-11: Robotic Perineal Radical Prostatectomy and Bilateral Lymph Node Dissection with Perineal Approach
We aimed to present a robotic perineal radical prostatectomy and bilateral pelvic lymph node dissection with perineal approach to a patient who is diagnosed with prostate cancer in this video.
A 66-year-old male patient underwent a true-cut biopsy of transrectal ultrasound guidance due to detected PSA 7.7, and the pathology was reported as Gleason 3 + 4 adenocarcinoma in 6/12 focus. No extra prostatic extension was detected in the lower abdominal magnetic resonance imaging for the multiparametric prostate. Patient had a diagnostic laparotomy history due to ileus. The patient underwent perineal incision in the exaggerationed lithotomy position. After the skin and subcutaneous fat passes, the rectum is released with surrounding fatty tissues and a gap is formed in the rectovesical space. After placing the gel port in the perineal region, a total of 3 robotic trocars and one assistant trocar were placed. Robotic radical prostatectomy and bilateral pelvic lymph node dissection were performed with perineal approach. Obturator and iliac lymph node groups were dissected and excised.
The procedure lasted 175 minutes and the estimated blood loss was 90 mL. No peroperative complication was detected. The patient was discharged on the third postoperative day. The result of the pathology was reported as Gleason 3 + 4. Surgical margin was negative. Lymph node metastasis reported in the pathology examination. PSA recurrence was not detected. There was no urinary incontinence at 3 months postoperatively.
Robotic radical prostatectomy and bilateral pelvic lymph node dissection with perineal approach are minimally invasive methods that can be safely performed in experienced centers.