V8-09: Robot Assisted Radical Prostatectomy For Prostates Over 100 Grams: Technique And Outcomes

Video

INTRODUCTION

Benign prostatic hyperplasia (BPH) is seen in more than 30% of men over 60 years age. It is not uncommon to encounter men with BPH having significant prostate cancer seeking treatment. Radical prostatectomy is technically challenging in very large prostate. We present our experience of robot assisted laparoscopic radical prostatectomy (RALP) in prostate weighing more than 100 gram. There are few studies reporting varying outcomes for >70 gm prostate. We compared RALP operative parameters and functional outcomes between 70-100 gm prostate with >100 gm prostate

METHODS

We retrospectively reviewed our IRB approved prostate cancer database. RALP specimen weighing more than 100 gram in 183 men (Group 1) and 70 to 100 gram in 647 men (group 2). We compared demographic, operative, oncologic and functional outcomes between these two groups. In this video we describe the technical nuances during RALP for very large prostate with prostate cancer and present their outcomes. Early ligation of dorsal venous complex (DVC) reduces venous blood loss during further dissection. Proper identification of bladder neck and anterior entry favors recognition of median lobe. After visualizing bilateral ureteric orifice, constant upward traction of median lobe by fourth arm is important to enter proper posterior plane. Mobilization of the prostate and retraction can be challenging in these patients. Fish-mouth reconstruction of bladder neck helps watertight vesico-urethral anastomosis and urinary continence

RESULTS

Patient profile, operative parameters, oncologic and functional outcomes are shown in table 1. Operative time and estimated blood loss was higher in group 1. Many of these patients were not potent or had low SHIM scores and therefore did not have full NS. Chance of achieving bilateral full nerve spare was less in group 1. Higher incidence of extra capsular extension was observed in group 2 but positive surgical margin was similar between groups. At 12 months more than 95% achieved continence and there was no difference in biochemical recurrence, continence and potency between groups

CONCLUSION

Very large prostate size has slightly longer operative time and more blood loss. Prostate size >100 gm may challenge bilateral full NS. But, oncological and functional outcomes are not compromised by prostate size in experienced surgeons hands

Funding: None