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Different Approaches to Robotic Simple Prostatectomy
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Different Approaches to Robotic Simple Prostatectomy Kasmira Radha Gupta , Kirolos Nazmi Meilika M.B.B.Ch. , Bheesham D. Dayal M.D. , Ketan K. Badani M.D. PII: DOI: Reference:
S2590-0897(19)30014-3 https://doi.org/10.1016/j.urolvj.2019.100015 UROLVJ 100015
To appear in:
Urology Video Journal
Received date: Revised date: Accepted date:
21 August 2019 28 September 2019 16 October 2019
Please cite this article as: Kasmira Radha Gupta , Kirolos Nazmi Meilika M.B.B.Ch. , Bheesham D. Dayal M.D. , Ketan K. Badani M.D. , Different Approaches to Robotic Simple Prostatectomy, Urology Video Journal (2019), doi: https://doi.org/10.1016/j.urolvj.2019.100015
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Different Approaches to Robotic Simple Prostatectomy
INTRODUCTION Robotic simple prostatectomy is becoming widespread for treatment of larger prostates.1 This video article examines two approaches: retropubic and transvesical. METHODS The retropubic, similar to the open Millin, involves dropping the bladder, developing the space of Retzius, and exposing and incising the anterior prostatic capsule longitudinally.2 The adenoma is separated from the surgical capsule by sweeping laterally using blunt dissection until the posterior prostatic capsule is reached. The posterior aspect of the bladder neck is approximated to the distal urethra after adenoma excision. In contrast, the transvesical mimics the simple open suprapubic.3 The bladder is not dropped and the space of Retzius not developed. The bladder dome is incised and 4 stay sutures tack it open. The mucosa is scored posterior to the median lobe to create a plane between the adenoma and the posterior surgical capsule which is continued circumferentially to include the lateral lobes. After adenoma removal, the bladder neck is approximated circumferentially to the distal urethra and the cystotomy is closed. RESULTS We compared results in 20 patients, 10 with each approach. The groups were similar in demographics and preoperative characteristics including BMI, PSA, prostate size, and PVR. Each approach was safely executed robotically without complications in either group and a hospital stay of 1 day in all 20 patients; however, EBL, operative time, and catheter indwell time were all lower for the transvesical group (75 ml vs. 150 ml, p = .067; 140 min vs. 210 min, p = .025; 6 vs. 10 days, p = ). CONCLUSION In this retrospective comparison we demonstrate differences in 2 approaches to robotic simple prostatectomy. Preliminary analysis demonstrates both to be safe and efficacious, but there appear to be some advantages for the transvesical approach that deserve prospective evaluation.
References:
1. Cockrell R, Bonzo J, Lee D. Robotic-Assisted Simple Prostatectomy. Journal of Endourology. 2018; Vol. 32, No. S1.
2. Elsamra SE, Gupta N, Ahmed H, Leavitt D, Kreshover J, Kavoussi L, Richstone L. Robotic assisted laparoscopic simple suprapubic prostatectomy – The Smith Institute for Urology experience with an evolving technique. Asian J Urol. 2014; 1(1): 55–59. 3. Leslie S., de Castro Abreu A.L., Chopra S., Ramos P., Park D., Berger A.K. Transvesical robotic simple prostatectomy: initial clinical experience. Eur Urol. 2014;66:321–329.
Different Approaches to Robotic Simple Prostatectomy Kasmira Radha Gupta , Kirolos Nazmi Meilika M.B.B.Ch. , Bheesham D. Dayal M.D. , Ketan K. Badani M.D. PII: DOI: Reference:
S2590-0897(19)30014-3 https://doi.org/10.1016/j.urolvj.2019.100015 UROLVJ 100015
To appear in:
Urology Video Journal
Received date: Revised date: Accepted date:
21 August 2019 28 September 2019 16 October 2019
Please cite this article as: Kasmira Radha Gupta , Kirolos Nazmi Meilika M.B.B.Ch. , Bheesham D. Dayal M.D. , Ketan K. Badani M.D. , Different Approaches to Robotic Simple Prostatectomy, Urology Video Journal (2019), doi: https://doi.org/10.1016/j.urolvj.2019.100015
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Different Approaches to Robotic Simple Prostatectomy
INTRODUCTION Robotic simple prostatectomy is becoming widespread for treatment of larger prostates.1 This video article examines two approaches: retropubic and transvesical. METHODS The retropubic, similar to the open Millin, involves dropping the bladder, developing the space of Retzius, and exposing and incising the anterior prostatic capsule longitudinally.2 The adenoma is separated from the surgical capsule by sweeping laterally using blunt dissection until the posterior prostatic capsule is reached. The posterior aspect of the bladder neck is approximated to the distal urethra after adenoma excision. In contrast, the transvesical mimics the simple open suprapubic.3 The bladder is not dropped and the space of Retzius not developed. The bladder dome is incised and 4 stay sutures tack it open. The mucosa is scored posterior to the median lobe to create a plane between the adenoma and the posterior surgical capsule which is continued circumferentially to include the lateral lobes. After adenoma removal, the bladder neck is approximated circumferentially to the distal urethra and the cystotomy is closed. RESULTS We compared results in 20 patients, 10 with each approach. The groups were similar in demographics and preoperative characteristics including BMI, PSA, prostate size, and PVR. Each approach was safely executed robotically without complications in either group and a hospital stay of 1 day in all 20 patients; however, EBL, operative time, and catheter indwell time were all lower for the transvesical group (75 ml vs. 150 ml, p = .067; 140 min vs. 210 min, p = .025; 6 vs. 10 days, p = ). CONCLUSION In this retrospective comparison we demonstrate differences in 2 approaches to robotic simple prostatectomy. Preliminary analysis demonstrates both to be safe and efficacious, but there appear to be some advantages for the transvesical approach that deserve prospective evaluation.
References:
1. Cockrell R, Bonzo J, Lee D. Robotic-Assisted Simple Prostatectomy. Journal of Endourology. 2018; Vol. 32, No. S1.
2. Elsamra SE, Gupta N, Ahmed H, Leavitt D, Kreshover J, Kavoussi L, Richstone L. Robotic assisted laparoscopic simple suprapubic prostatectomy – The Smith Institute for Urology experience with an evolving technique. Asian J Urol. 2014; 1(1): 55–59. 3. Leslie S., de Castro Abreu A.L., Chopra S., Ramos P., Park D., Berger A.K. Transvesical robotic simple prostatectomy: initial clinical experience. Eur Urol. 2014;66:321–329.