V10-01: Robot Assisted Simple Prostatectomy using the Millin’s, Frayer’s, Posterior, and Complete Anatomic Techniques
Multiple surgical techniques can be employed to accomplish robotic simple prostatectomy. After having gone through our own experience of open, laparoscopic and different robotic approaches we developed complete anatomical robotic simple prostatectomy preserving bladder neck and complete vesico-urethral anastomosis which can supplant the traditional open simple prostatectomy at centers using robotic assistance. In this video, we the classically describe techniques for robotic simple prostatectomy and describe our technique for the anatomic approach.
From May 2009 through 2015, a single surgeon performed RASP on 30 patients, who were referred with large prostate glands not amenable to TURP. Our port placement for the da Vinci Si and Xi are in figures 1 and 2. We performed these procedures using the traditional Millin’s retropubic approach, the traditional Frayer’s approach, the Posterior approach, and our anatomic approach.
The mean patient age was 70.8 years (61-86) and post void residual was 414 cc (123-750). Mean preoperative AUA Symptom Score (AUA-SS) was 14.75 (9-21). The average length of stay was 1.7 days (range 1-5). There were two complications during our series with one Clavien I and one Clavien II. Pathology demonstrated Gleason 3+3=6 prostate cancer in 20% of cases. Continuous bladder irrigation was not utilized and no transfusions were necessary. Post-operatively, AUA-SS scores were significantly improved to a mean of 4.25 at 6 months postop and all patients were able to void with PVR less than 200 cc.
Robot assisted simple prostatectomy can be considered as a viable surgical alternative in cases of large prostatic adenomas. Using this technique concomitant procedures such as cystolithotomy, diverticulectomy, and hernia repair can be performed quickly and avoid another procedure. Amongst all robotic techniques, we prefer complete anatomical robotic simple prostatectomy preserving bladder neck and complete vesico-urethral anastomosis.