摘要 Objective: Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement, open simple prostatectomy (OSP) remains the standard for large prostates (typically greater than 100 g).OSP, however, is associated with significant morbidity.Recently, a few reports touting robotic application to simple prostatectomy have been published.Herein, we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy (RALSSP) and detailed modifications in our technique as our experience increased.Methods: All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics, pre-operative features, and perioperative outcomes.All parameters were tabulated and mean values were calculated.Student's t-test was utilized with p < 0.05 deemed significant.Details regarding surgical technique were reviewed and highlighted.Results: Fifteen patients underwent RALSSP during this period.Mean age of these men was 69 years.Mean body mass index (BMI) was 28.5 kg/m2.American Society of Anesthesiologists (ASA) score was on average 2.4.Average international prostate symptom score (IPSS) was 16.2 with the majority of men experiencing some adverse clinical sequela of such benign prostatic hyperplasia (BPH).For those patients not in retention, preoperative post-void residual (PVR) was 428 mL.All patients underwent successful RALSSP without need for conversion or need for blood transfusion.Mean estimated blood loss (EBL) was 290 mL.Five patients underwent other concurrent procedures (e.g.cystolithotomy).Mean length of hospital stay (LOS) was 2.4 days and only five patients required continuous bladder irrigation (CBI) postoperatively.Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5 (p < 0.001).No major complications were identified.Adaptation of low transverse cystotomy, utilization of a robotic tenaculum in the #3 arm with its control by a surgeon on a second console, and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative outcomes.Conclusion: RALSSP allows for feasible performance of prostate adenoma enucleation with low risk of blood transfusion, short LOS, and significant improvement in IPSS and PVR; all while maintaining a minimally invasive approach.The use of a robotic tenaculum controlled by the secondary console and the mucosal advancement facilitate excellent outcomes and may play a role in minimizing hematuria and need for CBI.
Abstract: Objective: Despite a multitude of minimally invasive surgical options available for benign prostatic enlargement, open simple prostatectomy (OSP) remains the standard for large prostates (typically greater than 100 g).OSP, however, is associated with significant morbidity.Recently, a few reports touting robotic application to simple prostatectomy have been published.Herein, we reviewed our series of robotic assisted laparoscopic simple suprapubic prostatectomy (RALSSP) and detailed modifications in our technique as our experience increased.Methods: All RALSSP cases performed between January 2013 and January 2014 were reviewed for demographics, pre-operative features, and perioperative outcomes.All parameters were tabulated and mean values were calculated.Student's t-test was utilized with p < 0.05 deemed significant.Details regarding surgical technique were reviewed and highlighted.Results: Fifteen patients underwent RALSSP during this period.Mean age of these men was 69 years.Mean body mass index (BMI) was 28.5 kg/m2.American Society of Anesthesiologists (ASA) score was on average 2.4.Average international prostate symptom score (IPSS) was 16.2 with the majority of men experiencing some adverse clinical sequela of such benign prostatic hyperplasia (BPH).For those patients not in retention, preoperative post-void residual (PVR) was 428 mL.All patients underwent successful RALSSP without need for conversion or need for blood transfusion.Mean estimated blood loss (EBL) was 290 mL.Five patients underwent other concurrent procedures (e.g.cystolithotomy).Mean length of hospital stay (LOS) was 2.4 days and only five patients required continuous bladder irrigation (CBI) postoperatively.Postoperative PVR improved to a mean of 33 mL and IPSS improved to 4.5 (p < 0.001).No major complications were identified.Adaptation of low transverse cystotomy, utilization of a robotic tenaculum in the #3 arm with its control by a surgeon on a second console, and the utilization of mucosal advancement have all subjectively aided in performance of RALSSP and perioperative outcomes.Conclusion: RALSSP allows for feasible performance of prostate adenoma enucleation with low risk of blood transfusion, short LOS, and significant improvement in IPSS and PVR; all while maintaining a minimally invasive approach.The use of a robotic tenaculum controlled by the secondary console and the mucosal advancement facilitate excellent outcomes and may play a role in minimizing hematuria and need for CBI.
Sammy E. Elsamra, Nikhil Gupta, Haris Ahmed, David Leavitt, Jessica Kreshover, Louis Kavoussi, Lee Richstone. Robotic assisted laparoscopic simple suprapubic prostatectomy—The Smith Institute for urology experience with an evolving technique[J]. Asian Journal of Urology, 2014, 1(1): 52-56.
Sammy E. Elsamra, Nikhil Gupta, Haris Ahmed, David Leavitt, Jessica Kreshover, Louis Kavoussi, Lee Richstone. Robotic assisted laparoscopic simple suprapubic prostatectomy—The Smith Institute for urology experience with an evolving technique. Asian Journal of Urology, 2014, 1(1): 52-56.
Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, Chang SL,et al. Morbidity and mortality after benign prostatic hyperplasiasurgery: data from the american college of surgeons national surgicalquality improvement program. J Endourol 2014; 28: 831-40.
[2]
Health Quality Ontario. Energy delivery systems for treatment ofbenign prostatic hyperplasia: an evidence-based analysis. Ont HealthTechnol Assess Ser 2006; 6: 1-121.
Suer E, Gokce I, Yaman O, Anafarta K, Gö?ü? O. Openprostatectomy is still a valid option for large prostates: a highvolume,single-center experience. Urology 2008; 72: 90-4.
[5]
Vora A, Mittal S, Hwang J, Bandi G. Robot-assisted simpleprostatectomy: multi-institutional outcomes for glands larger than100 grams. J Endourol 2012; 26: 499-502.
[6]
Weiss BE, Wein AJ, Malkowicz SB, Guzzo TJ. Comparison ofprostate volume measured by transrectal ultrasound and magneticresonance imaging: is transrectal ultrasound suitable to determinewhich patients should undergo active surveillance? Urol Oncol2013; 31: 1436-40.
[7]
Mariano MB, Graziottin TM, Tefilli MV. Laparoscopicprostatectomy with vascular control for benign prostatic hyperplasia.J Urol 2002; 167: 2528-9.
[8]
McCullough TC, Heldwein FL, Soon SJ, Galiano M, BarretE, Cathelineau X, et al. Laparoscopic versus open simpleprostatectomy: an evaluation of morbidity. J Endourol 2009; 23:129-33.
[9]
Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, etal. Robotic simple prostatectomy. J Urol 2008; 179: 513-5.
[10]
John H, Bucher C, Engel N, Fischer B, Fehr JL. Preperitonealrobotic prostate adenomectomy. Urology 2009; 73: 811-5.
Sutherland DE, Perez DS, Weeks DC. Robot-assisted simpleprostatectomy for severe benign prostatic hyperplasia. J Endourol2011; 25: 641-4.
[13]
Coelho RF, Chauhan S, Sivaraman A, Palmer KJ, Orvieto MA,Rocco B, et al. Modified technique of robotic-assisted simpleprostatectomy: advantages of a vesico-urethral anastomosis. BJU Int2012; 109: 426-33.
[14]
Matei DV, Brescia A, Mazzoleni F, Spinelli M, Musi G, MelegariS, et al. Robot-assisted simple prostatectomy (RASP): does it makesense? BJU Int 2012; 110(11 Pt C): E972-9.
[15]
Leslie S, de Castro Abreu AL, Chopra S, Ramos P, Park D, BergerAK, et al. Transvesical robotic simple prostatectomy: initial clinicalexperience. Eur Urol 2014; pii: S0302-2838(13)01381-X. doi:10.1016/j.eururo.2013.12.020. [Epub ahead of print]
Christopher Hartman, Nikhil Gupta, David Leavitt, David Hoenig, Zeph Okeke, Arthur Smith. Advances in percutaneous stone surgery[J]. Asian Journal of Urology, 2015, 2(1): 26
-32
.
