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 doi:

Original Article

Robotic assisted laparoscopic simple suprapubic prostatectomy—The Smith Institute for urology experience with an evolving technique

Sammy E. Elsamra, Nikhil Gupta, Haris Ahmed, David Leavitt, Jessica Kreshover, Louis Kavoussi, Lee Richstone

The Smith Institute for Urology, New Hyde Park, New York, USA

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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.

Key words： Robotic assisted laparoscopic simple suprapubic prostatectomy Benign prostatic hyperplasia Blood loss Hospital stay

Received: 15 July 2014 Published: 28 October 2014

Corresponding Authors: Lee Richstone E-mail: lrichsto@nshs.edu

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	Sammy E. Elsamra
	Nikhil Gupta
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	David Leavitt
	Jessica Kreshover
	Louis Kavoussi
	Lee Richstone

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Cite this article:

Sammy E. Elsamra,Nikhil Gupta,Haris Ahmed, et al. 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.

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http://www.ajurology.com/EN/ OR http://www.ajurology.com/EN/Y2014/V1/I1/52

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