V1027: Robot-assisted simple prostatectomy

Video

Introduction and Objectives
To date, no comparative study has been performed to examine outcomes following robot-assisted simple prostatectomy (RASP) vs. open simple prostatectomy (OSP). Nevertheless, OSP is a highly morbid procedure with frequent need for prolonged catheterization and blood transfusion. Robot-assisted simple prostatectomy has been shown to mitigate these sequelae albeit in relatively small case series.

Methods
Our patient was a 66 year-old male who presented with a history of bothersome lower urinary tract symptoms. His preoperative IPSS was 22 and uroflowmetry demonstrated a peak flow of 8ml/sec. 12-core transrectal ultrasound guided biopsy was negative and ultrasound estimated volume was 138mL. The technique demonstrated is a transperitoneal hybrid approach of urethrovesical anastomosis with the posterior urethral plate reapproximated to the posterior bladder neck, coapting much of the prostatic fossa.

Results
Operative time was 3hr 17min. The final specimen was 154 grams. Estimated operative blood loss was 110mL and the patient’s post-operative hemoglobin dropped 1.3 g/dL. The patient was discharged from the hospital postoperative day 2 and transurethral catheter was removed after 7 days. At 4 months, the patient was found to have had a 12-point decrease in IPSS. He is doing well, with no sign of recurrent flow obstruction at 8 months of follow-up.

Conclusions
Robot-assisted simple prostatectomy is technically feasible and represents an alternative to open simple prostatectomy or endourologic approaches, especially for large adenomas.

Funding: none