V4-04: Technical aspects of robot-assisted laparoscopic prostatectomy in large prostates (≥75g).
VideoIntroductions and Objectives
Robot-assisted radical prostatectomy (RARP) in patients with voluminous prostate glands is known to be challenging. The objective of this video-abstract is to show specific technical approaches to the different steps of RARP in patients with large prostate glands (≥75g) and to analyse the impact of prostate weight on peri-operative surgical and pathological outcomes.
We analysed the prospectively collected peri-operative and pathological data of all men undergoing RARP at our centre between July 2010 and May 2014. Men were divided into three groups depending on the weight of the pathological prostate specimen: small (
Data from 1004 men were included in our analysis. Of these, 589 (59%) radical prostatectomy specimens were classified as small, 315 (31%) as medium and 100 (10%) as large. Patients with large prostates were significantly older and had a higher pre-op PSA values than patients with smaller glands (mean age 66 vs 65 vs 61 years, PSA 11.5 vs 9.3 vs 6.5ng/ml for large, medium and small glands respectively). _x000D_ Comparable to literature, operation time and estimated blood loss were significantly elevated in the large prostate group (mean operation time 197 vs 186 vs 177 min and mean blood loss 304 vs 222 vs 187ml for large, medium and small glands respectively). Hospital stay, transfusion rates (
RARP in men with large prostates can be technically challenging, as illustrated by longer operation times and higher peri-operative blood loss. Nevertheless, several surgical techniques can be applied to facilitate surgery on large glands, allowing the operation to be performed with similar complication rates and similar oncological efficacy.