V1273: Robotic radical prostatectomy following sleeve gastrectomy with concomitant abdominoplasty, case report

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Introduction and Objectives
Robotic surgery may be diificult in patients with morbid obesity. Even patients undergoing rapid weight loss present challenges due to an often large and redundant pannus. We present a novel approach of concomitant robotic radical prostatectomy following and abdominoplasty in a morbidly obese patient with prostate cancer.

Methods
A 53 year old male with a BMI of 55.16 kg/m2 (grade III obesity) presented with a PSA of 4 ng/ml and Gleason 6 (3+3) adenocarcinoma of the prostate without evidence of metastatic disease. First, a laparoscopic partial gastrectomy was performed resulting in a weight loss of 57lb in 8 weeks (BMI 45.7 kg/m2). Second, we performed robotic-assisted laparoscopic prostatectomy (RALP) and concomitant abdominoplasty described by Regnault. The excessive skin and subcutaneous tissues was excised using “fleur de lis” technique, resulting in an inverted “T” shape scar. Sunsequently, robotic access and subsequent prostatectomy was performed through the exposed abdominal fascia devoid of overlying integument. Lastly, the port sites were closed and the skin flaps re-approximated thereby completing the abdominoplasty. We left 2 subcutaneous drains without placing any intra-abdominal drain.

Results
The procedure was technically successful without need for conversion to open surgery. Total operative time was 270 min (180 minutes for the abdominoplasty and 90 minutes for the robotic prostatectomy). Estimated blood loss was 1000 cc ( abdominoplasty 900cc, prostatectomy 100 cc). The skin excised from the abdominal wall weighed 44lb. The hospital stay was 4 days, and Foley catheter was removed on the 14th postoperative day. Final pathology confirmed adenocarcinoma Gleason score 6 (3 +3) with negative surgical margins. At 1 month follow-up the patient reported mild urinary incontinence (1 pad/day) and SHIM score of 15 with PDE5-inhibitors (baseline SHIM 23).

Conclusions
Combined abdominoplasty and robotic radical prostatectomy offers an attractive option for surgical treatment in morbidly obese individuals with prostate cancer. This principle may be extended to various conditions in obese patients that require surgical treatment.

Funding: None