V5-06: Robot-assisted simple prostatectomy in patients with large volume BPH (>100 ml): indications, technique and results based on 81 procedures
Open adenomectomy (OSP) is still considered the gold standard surgical treatment for patients with large volume benign prostatic hyperplasia (BPH). Recently, minimally invasive techniques has been proposed in order to reduce the morbidity and complication rates. Here we present the technique and results of our Robot-assisted simple prostatectomy (RASP) series.
81 patients with large volume BPH (>100 ml) underwent RASP through a transperitoneal access. All the procedures were performed with the DaVinci Si robotic system in a four arm configuration. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Baseline functional parameters including International Prostate Symptom Score (IPSS), Maximum Flow Rate (Qmax) and Post-Void Residual (PVR) were assessed postoperatively during the follow-up. Perioperative outcomes included operative time (OR time), catheterization time (CV time) and length of hospital stay (LOS). Complications were recorded and graded according to the Clavien-Dindo classification.
The median age was 69 years (IQR 66-76) and 48 (62%) of the patients had a Charlson Comorbidity Index of 2 or more. The median prostate volume was 130 ml (IQR 111–190) and 28 (34%) patients had an indwelling catheter prior surgery. Patients showed a significative improvement of functional outcomes, with a median Qmax improvement of +15 ml/s and a decrease of the IPSS and PVR of -20 and -73 ml respectively. The median OR time was 105 min (IQR 85-150) and the median estimated blood loss was 250 ml (IQR 105-320). The median CV time and LOS time was 3 and 4 days respectively. The overall postoperative complication rate was 31% with no grade 4 and 5 complications.
In our RASP series we obtained a significative improvement of functional outcomes with an acceptable risk of peri-operative complications. This technique could be considered an interesting option for surgeons that have completed their learning curve performing an adequate number of robot-assisted radical prostatectomys and in case of concomitant pathologies needing a surgical approach as vescical stones, bladder diverticula or inguinal hernia.