V6-13: Robotic-assisted Laparoscopic Simple Prostatectomy: Technique and Outcomes
VideoIntroductions and Objectives
Open simple prostatectomy continues to be the gold standard for symptomatic, large-gland BPH. A robotic approach to this procedure has the potential advantages of minimizing perioperative morbidity and familiarity to the busy robotic prostate surgeon. We describe our technique and experience with robotic-assisted laparoscopic simple prostatectomy (RALSP).
Our operative setup is identical to robotic-assisted radical prostatectomy in terms of patient positioning and port placement. The bladder is released from the anterior abdominal wall and the endopelvic fascia is incised bilaterally. With the aid of the 4th robotic arm, the bladder is opened and the adenoma can be retracted superiorly, facilitating identification of the adenoma enucleation plane. This plane is taken laterally and apically with careful attention not to disrupt the trigone or the prostatic capsule. The specimen is removed and placed in an Endocatch bag. A hemostatic and mucosal advancement suture is placed in the posterior aspect, and the cystotomy is closed. A large catheter and a closed-suction drain are left in place.
Over the past 2 years, 17 patients with large-gland symptomatic BPH have been treated with this approach. Median preoperative gland size was 130 gms and the majority of patients (11/17) previously experienced in urinary retention. Median operative time was 174 minutes and median blood loss was 200 ml. One patient (6%) required a blood transfusion. No major complications were observed.
RALSP is safe and feasible in patients with bothersome urinary symptoms from large gland BPH. Patients with prior outlet procedures, urinary retention, and very large glands (>150 gm) can all be adequately treated with this approach. Surgeons with significant robotic experience, especially with radical prostatectomy, may consider utilizing this approach for their patients with large-gland BPH.