To present our initial experience with single-port percutaneous transvesical simple prostatectomy using the novel SP robotic surgical system.
Ten patients underwent single-port transvesical simple ...prostatectomy between February and November 2019. Percutaneous access to the bladder dome was made and all SP instruments were inserted through the SP multichannel cannula directly into the bladder. Prostate adenoma enucleation, hemostasis and trigonization were done according to the principles of open simple prostatectomy technique. Demographics and perioperative outcomes were prospectively collected and analyzed.
All procedures were performed successfully without the need for conversion to open surgery. Median preoperative estimated prostate size was 159 (Interquartile range (IQR) 108-223) grams.
No intraoperative complications occurred. Median operative time and estimated blood loss were 190 (IQR 146-203) minutes and 100 (IQR 68-175) ml, respectively. Mean postoperative specimen weight was 84.3 ± 34 grams. Median length of hospital stay was 19 (IQR 17-28) hours. All patients were satisfied with their urinary flow after catheter removal without any episode of acute urinary retention 1-6 months, postoperatively.
Single-port transvesical simple prostatectomy can be offered as an alternative treatment option for surgical management of lower urinary tract symptoms associated with large prostate adenoma. Sparing the peritoneal cavity, minimum dissection of the bladder, excellent visualization of the prostate fossa can be some of the potential advantages of this minimally invasive approach. Comparative studies with standard techniques are advisable to evaluate the surgical outcome and postoperative morbidity of each treatment modality.
INTRODUCTIONTo present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system ...(Intuitive Surgical, Sunnyvale CA, EE.UU.). PATIENT AND METHODSA 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA, EE.UU.) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform. RESULTSTotal operative time was 256minutes (min) with a console time of 108min for radical prostatectomy, and 101min for the partial nephrectomy respectively, including a warm ischemia time of 26min. Estimated blood loss was 250cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4+3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected. CONCLUSIONSThe single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.
To present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system (Intuitive ...Surgical, Sunnyvale CA).
A 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3 cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform.
Total operative time was 256 minutes (min) with a console time of 108 min for radical prostatectomy, and 101 min for the partial nephrectomy respectively, including a warm ischemia time of 26 min. Estimated blood loss was 250cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4 + 3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected.
The single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.
Presentar el primer caso de cirugía multicuadrante concomitante —prostatectomía radical robótica y nefrectomía parcial robótica izquierda— realizadas con técnica de puerto único utilizando el sistema quirúrgico da Vinci SP® (Intuitive Surgical, Sunnyvale CA).
Masculino de 66 años con diagnóstico de cáncer de próstata localizado y lesión sospechosa en riñón izquierdo encontrada en tomografía axial computarizada (TAC) durante evaluación de cáncer de próstata. Ambos procedimientos se realizaron usando una sola incisión de 3 centímetros, y un puerto laparoscópico adicional; utilizando un Gelpoint® estándar (Applied Medical, Rancho Santa Margarita, CA) y replicando la técnica previamente descrita de puerto único para prostatectomía radical robótica y nefrectomía parcial con el uso de la plataforma Robótica puerto único prostatectomía SP®.
Tiempo operatorio total fue 256 minutos (min); con un tiempo de consola de 108 min para la prostatectomía radical, y 101 min para la nefrectomía parcial respectivamente, incluyendo un tiempo de isquemia de 26 min. Pérdida sanguínea estimada fue 250 cc. No sé necesito transfusión. Patología final de próstata fue adenocarcinoma Gleason 7 (4 + 3) y para la lesión renal fue carcinoma de células renales. Después de dos meses de seguimiento, PSA fue indetectable, sin recurrencia o complicaciones.
La técnica de puerto único presenta ventajas como mas fácil planificación quirúrgica y transición para cirugías combinadas y multicuadrantes, recuperación mas rápida, dolor postoperatorio mínimo y menor uso de opioides, además de excelentes resultados cosméticos. Sugerimos que procedimientos combinados deberían ser realizados solo en instituciones con un alto volumen de pacientes, por cirujanos con amplia experiencia en cirugía robótica y en pacientes seleccionados.
Over the years, several techniques for performing robot-assisted prostatectomy have been implemented in an effort to achieve optimal oncological and functional outcomes.
To provide an evidence-based ...description and video-based illustration of currently available dissection techniques for robotic prostatectomy.
A literature search was performed to retrieve articles describing different surgical approaches and techniques for robot-assisted radical prostatectomy (RARP) and to analyze data supporting their use. Video material was provided by experts in the field to illustrate these approaches and techniques.
Multiple surgical approaches are available: extraperitoneal, transvesical, transperitoneal posterior, transperitoneal anterior, Retzius sparing, and transperineal. Surgical techniques for prostatic dissection sensu strictu are the following: omission of the endopelvic fascia dissection, bladder neck preservation, incremental nerve sparing by means of an antegrade or retrograde approach, and preservation of the puboprostatic ligaments and dorsal venous complex. Recently, techniques for total or partial prostatectomy have been described.
Different surgical approaches and techniques for robotic prostatectomy have been analyzed.
Two randomized controlled trials evaluating the extraperitoneal versus the transperitoneal approach have demonstrated similar results. Level I evidence on the Retzius-sparing approach demonstrated earlier return to continence than the traditional anterior approach. The question whether Retzius-sparing RARP is associated with a higher rate of positive surgical margins is still open due to the intrinsic bias in terms of surgical expertise in the available comparative studies. This technique also offers an advantage in patients who have received kidney transplantation. Retrospective evidence suggests that the more the anatomical dissection (eg., more periprostatic tissue is preserved), the better the functional outcome in terms of continence. Yet, two randomized controlled trials evaluating the different techniques of dissection have so far been produced. Partial prostatectomies should not be offered outside clinical trials.
Several techniques and approaches are available for prostate dissection during RARP. While the Retzius-sparing approach seems to provide earlier return to continence than the traditional anterior transperitoneal approach, no technique has been proved to be superior to other(s) in terms of long-term outcomes in randomized studies.
We have summarized available approaches for the surgical treatment of prostate cancer. Specifically, we described the different techniques that can be adopted for the surgical removal of the prostate using robotic technology.
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