V8-12: Combining antegrade and retrograde dissection during salvage robotic radical prostatectomy
Recently published series of salvage robotic radical prostatectomy for radiorecurrent prostate cancer showed the feasibility and the safety of this complex surgical procedure with favorable perioperative and satisfactory functional outcomes. This video shows surgical steps of a salvage robotic radical prostatectomy with pelvic lymph node dissection for radio recurrent prostate cancer.
_x000D_ _x000D_ We present a case of a 60 yr old patient who underwent primary radiation therapy in 2007 for a G7(3+4) prostate cancer. Due to a raising PSA, a prostate biopsy showed a G7(4+3) prostate cancer of the right lobe. A 18F Choline PET/CT was negative for nodal and distant metastasis. _x000D_ With the patient in a steep trendelenburg position a five trocar access was performed. Bilateral extended pelvic lymph node dissection was completed. The Retzius space was developed and the endopelvic fascia bilaterally incised. After sealing the dorsal vein complex with Ligasure, urethral stump was meticulously prepared and transected. The apex was retrogradely dissected up to identifying the Denonvilliers fascia, before moving to bladder neck isolation. Bladder neck was isolated and sectioned and seminal vesicles dissected. The Denonvilliers fascia was identified and opened and the dissection plane, previously prepared retrogradely, was identified. Bilateral extrafascial radical prostatectomy was completed. A Van Velthoven anastomosis with posterior muscolo-fascial reconstruction was performed. _x000D_ _x000D_
Operative time was 132 minutes. Blood loss was 300 ml. Postoperative course was uneventful and the patient was discharged on 3rd postoperative day. Pathologic examination showed a pT2bN0 G7(4+3) prostate cancer with negative surgical margins. One-mo PSA levels were 0.01 ng/mL. At 6 month follow up PSA level remained 0 and patient was continent._x000D_ _x000D_
Combining retrograde and antegrade dissections during salvage robotic radical prostatectomy may contribute to a safe development of the posterior dissection plane. Salvage robot assisted radical prostatectomy is a feasible treatment option for patients with radiorecurrent prostate cancer. _x000D_ _x000D_