V4-13: Posterior Approach to Robotic Simple Prostatectomy
VideoIntroductions and Objectives
This video describes our novel technique for performing robotic simple prostatectomy (RSP) for benign prostatic hyperplasia (BPH). This approach also allows for performance of concomitant procedures such as bladder diverticulectomy, cystolithotomy, or ureteral reimplantation.
From May 2013 through September 2014, a single surgeon (DE) performed RSP on 21 patients with symptomatic BPH using our posterior approach technique. Novel aspects of this technique include a posterior cystotomy and anastomotic exclusion of the prostatic fossa. The posterior cystotomy offers easy visualization of the enlarged gland without mobilization of the bladder. Closure of the prostatic fossa is achieved by anastomosing the urethra to the bladder neck in an extraperitoneal fashion, after adenoma removal, obviating the need for post-operative bladder irrigation. Concomitant procedures performed included bladder diverticulectomy (3), cystolithotomy, and ureteral reimplantation.
The mean patient age was 68 years (60-85) and mean prostatic volume was 128.5 cc via transrectal ultrasound (55-200). Mean pre-operative IPSS score and SHIM score were 19.9 (7-28) and 11.9 (1-24) respectively. Average console time was 168.5 min (71-307) and average EBL was 276.2 mL (range 50-1000). The mean weight of removed adenoma was 84.5 grams (34-153). The average length of stay was 1.1 days (range 1-3). There were no intraoperative urologic complications and pathology confirmed BPH in all cases except 1 patient with incidental pT1a disease. Post-operative complications consisted of 1 initial failed voiding trial. Post-operatively, IPSS scores were significantly improved (Mean 4.2, range 0-12, p
We present our experience with this novel approach to RSP. Patients who underwent RSP had significant improvement in post-operative lower urinary tract symptoms without compromise in erectile function. The benefits of this approach include extraperitoneal anastomosis, elimination of post-operative bladder irrigation and shorter hospital stay.