V08-12: Robot-Assisted Placement of Pelvic Tissue Expander for Radiation after Prostatectomy and Cystectomy for Treatment of Prostate Cancer Biochemical Recurrence
Local treatment of biochemical recurrence of prostate cancer after surgical resection of the prostate and bladder is complicated by the interposition of small bowel in the empty prostatic bed. Salvage radiotherapy to the prostatic fossa has the increased morbidity associated with treatment levels of radiation applied to the small bowel. Commonly utilized radiation spacers focus on reduction of the doses applied to the rectum, however the morbidity of small bowel radiation is significantly higher than that of the rectum. Surgical spacers and mesh retention placement have been utilized previously in reports with other pelvic cancers. We present a robot-assisted surgical technique for overcoming the challenges of a patient with two prior pelvic surgeries and small bowel in the radiation target.
A 72-year-old male required treatment of his biochemical recurrent prostate cancer. In 2006 this patient presented with a PSA of 5.74, Gleason 3+3 prostate cancer. He underwent a robot-assisted laparoscopic radical prostatectomy for pT2a disease. In 2008, the patient was found to have muscle invasive high grade papillary urothelial carcinoma and underwent robot-assisted cystectomy and ileal conduit with final pathology pT2bN0 disease. In 2017 he had biochemical recurrence of his prostate cancer with a PSA of 0.30. Pelvic CT showed small bowel deep into his prostatic bed behind the pubic bone. A robot-assisted lysis of adhesions and placement of a PMT corporation tissue expander in the prostatic fossa was performed. Three robotic ports and one assistant port were utilized. The sigmoid and small bowel were displaced during lysis of adhesions. The tissue expander was passed through the midline trocar site deflated and inflated after entry into the abdomen. This was filled with 330 cc of saline. The tissue expander was secured with proline sutures in a dependent position. The patient subsequently underwent IRMT of 66 Gray to the prostatic fossa. Eleven days after IMRT the patient underwent successful laparoscopic removal of the tissue expander.
The patient tolerated IMRT without any complications. There were no gastrointestinal complaints following radiation therapy.
Robotic placement of a tissue expander in patients who have undergone multiple pelvic surgeries is a feasible procedure that can reduce the morbidity associated with pelvic radiation.