V1-12: ROBOTIC-ASSISTED RADICAL PROSTATECTOMY AND CONTINENT URINARY STOMA (MITROFANOFF) IN A 7 YEAR CHILD.
Prostate embryonal rhabdomyosarcoma (ERMS) is a common tumour in infants and children, It is characterized by a high degree of malignancy, both local rapid growth with formation of large pelvic masses, often leading to renal failure due to urethral obstruction, and systemic spread, commonly to the lungs, liver and bone. Several therapeutic approaches have been employed in the effort to treat prostate ERMS. In surgical therapy , bladder preservation is an important goal. We report a case of prostate embryonal rhabdomyosarcoma (ERMS) in a 7 year old child with a surgical robot assisted approach. _x000D_
We performed a robotic-assisted laparoscopic transperitoneal prostatectomy and a continent urinary stoma (Mitrofanoff) with a 4 arm Si Da Vinci surgical system. The patient had previously received 6 cycles of chemotherapy. Two with vincristine, doxorubicin and actinomycin with a partial response evaluated by size of the tumour deciding to switch to a regimen of second-line drugs, receiving 4 cycles with etoposide and cisplatin with an acceptable response._x000D_ Intraoperative endoscopy showed no bladder involvement_x000D_
Dissection of anterior bladder wall, lateral prostate dissection. Proximal section of the bladder neck two centimeters away from the bladder trigone. Posterior prostate resection with careful margins of tumour, Bladder neck closure suture in two layers, cystostomy catheter (12fr) placement and preparation of urinary stoma with Mitrofanoff technique. Surgical time was 8 hours. There were no post op complications. Hospital stay was 4 days._x000D_
A Robotic-assisted surgical approach in prostate embryonal rhabdomyosarcoma (ERMS) in pediatric patients is feasible, offering the advantages of mini-invasive techniques. More cases will be needed to validate their application. _x000D_