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V6 Robot assisted endoscopic extraperitoneal seminal vesical tip and nerve sparing radical prostatectomy
V5
V6
ROBOTIC-ASSISTED LAPAROSCOPIC TRANSPERITONEAL RADICAL PROSTATECTOMY
ROBOT ASSISTED ENDOSCOPIC EXTRAPERITONEAL SEMINAL VESICAL TIP AND NERVE SPARING RADICAL PROSTATECTOMY
Gaboardi E, Lissiani A., Simonato A., Gregori A., Galli S., Bozzola A.
Muentener M. Schmid D.M., Strebel R.T., Hanri D., John H.A.
"L. Sacco" Hospital, Urology, Milan, Italy
University Hospital Ztirich, Urology, Zurich, Switzerland
INTRODUCTION & OBJECTIVES: In January 2001 we initiated a laparoscopic radical prostatectomy program, with the collaboration of Tullio Sulser from Swisse. After performing 200 cases according to the classical Montsouris technique, we started an evaluation program of robot-assisted radical prostatectomy using daVinci tm Surgical System. We present a video of our current approach to robot-assisted radical prostatectomy.
INTRODUCTION & OBJECTIVES: Since the laparoscopic approach for radical surgical treatment of localized prostate cancer has emerged, an increasing number of specialized centres report good results with this new technique. More recently robot assisted systems have been introduced to facilitate the techniqually very demanding procedure and may allow an even better visualization of the anatomy and a more precise dissection of vital structures. In our video we show a robot assisted endoscopic extraperitoneal seminal vesical tip and nerve sparing radical prostatectomy as it is performed in our institution.
MATERIAL & METHODS: We use a five-port technique. A U-shaped incision is made on the Douglas pouch and both seminal vesicles and vasa are isolated and prerectal space is developed after the incision of the Denonvillier's fascia. An inverted U-shaped incision is made on the surface of the peritoneum laterally to both the umbilical arteries in order to create subperitoneal space. A bilateral pelvic fascia incision is done and ligation of the dorsal vein complex is completed. The bladder neck dissection and division permits to reach the vasa and the seminal vesicles previously isolated. Both lateral prostatic pedicles are transacted and apical dissection and division of the urethra are performed. The specimen is inserted into the endobag. Bilateral lymphadenectomy is completed and the urethro-vescical anastomosis is performed by single stitches. RESULTS: We performed the comparison of our first ten robot-assisted radical prostatectomy (R-ARP) with our first ten laparoscopic radical prostatectomy (LRP). The mean operative time was 246 rain. for R-ARP vs. 320 min. for LRP, the mean blood loss was 110 cc for R-ARP vs. 515 cc for LRP and the mean hospitalization was 4.8 days for R-ARP vs. 6.5 days for LRP.
MATERIAL & METHODS: Since September 2002 we performed 120 robot assisted laparoscopic radical prostatectomies using a daVinci robotic system. We initially adopted the Montsouris technique and in 44 of the most recent 45 procedures we used an extrapertioneal approach. With growing experience slight modifications have constantly been made to optimize our surgical technique. The seminal vesical tips as well as the neurovascular bundles were spared when this was oncologically acceptable. RESULTS: Mean operative time including installation of the robotic system was 250 minutes. No procedure had to be converted to open surgery. Our early oncological results are comparable to the results that are known from large series of open retropubic radical prostatectomies. However, in regard to blood loss, postoperative pain and hospital stay the endoscopic approach is superior to open surgery.
CONCLUSIONS: In an experienced centre in laparoscopic surgery, the learning curve of robotic radical prostatectomy is extremely short and blood loss and hospitalization are extremely favourable.
CONCLUSIONS: As shown in our video, the robot assisted endoscopic extraperitoneal approach allows a very precise anatomical prostatectorny. It offers patients the benefits of minimal invasive surgery without compromising oncological or functional results.
LAPAROSCOPIC CYSTECTOMY FOR BLADDER CANCER: DESCRIP-
LAPAROSCOPIC CYSTOPROSTATECTOMY
V8 TION STEP BY STEP Cathelineau X., Rozet E, Lorin S., Duncan W., Arroyo C., Barret E. Vaessen C., Mouzin M., Game X., Berrogain N., Malavaud B., Rischmann P. Institut Montsouris, Paris, France CHU Rangueil, Department of Urology, Toulouse, France INTRODUCTION & OBJECTIVES: Radical eystoprostatectomy is the gold INTRODUCTION & OBJECTIVES: Laparoscopie cysteetomies have been recently described but still under evaluation. This movie shows with precision the different steps for a safe, bloodless and carcinologic cystectomy.
standard treatment for invasive bladder tumours. The laparoseopic approach is currently being evaluated worldwide. We report the surgical technique of laparoseopic radical cystoprostatectomy and Bricker urinary diversion by a small midline incision that is used to remove the surgical specimen.
MATERIAL & METHODS: The opening of the peritoneum is shown as well as the dissection of the seminal vesicles, vas deferens, ureters, bladder and prostatic pedicles. It also shows the topographic relations between those elements. The continent bladder reconstruction is done through a small sub-umbilical
MATERIAL & METHODS: Between May 2001 and May 2004, we performed 70 laparoscopie cystectomies (including cystoprostateetomy, prostate sparing cystectomy and anterior pelvectomy) for bladder cancer. This video exemplifies the different surgical steps of the laparoscopic cystoprostatectomy.
incision and nreteral re-implantations are realized extra-corporeally. The neobladder anastomose to the ttrethra is done by laparoscopy.
RESULTS: A total of 26 cystoprostatectornies with Bricker urinary diversion
have been performed with a median operating time of 239 minutes (180-340), and RESULTS:
17 patients have been operated on with this technique.
median blood loss was 740 ml (100-1900). There have been no conversions to
Mean operative time was 6.6 +/- 1.8 hours and blood loss was 427 +/- 249 mI.
open, no major complications, or reoperations. The postoperative complications
Hospital stay was 14.2 +/- 3.5 days.
include 2 patients with a pelvic hematoma. The pathology results showed negative margins and there have been no trocar site seeding.
CONCLUSIONS:
In those groups trained in laparoscopic procedures,
laparoscopic radical cysteetomy is a safe option, associated with shorter hospital
CONCLUSIONS: Laparoscopic cystoprostatectomy with Bricker urinary
stays and gentler postoperative recovery. Longer follow up will be request for
diversion is feasible with little morbidity. Long term" follow-up is needed to
carcinologic evaluation.
confirm the oncologic results.
European Urology Supplements 4 (2005) No. 3, pp. 273
V6
ROBOTIC-ASSISTED LAPAROSCOPIC TRANSPERITONEAL RADICAL PROSTATECTOMY
ROBOT ASSISTED ENDOSCOPIC EXTRAPERITONEAL SEMINAL VESICAL TIP AND NERVE SPARING RADICAL PROSTATECTOMY
Gaboardi E, Lissiani A., Simonato A., Gregori A., Galli S., Bozzola A.
Muentener M. Schmid D.M., Strebel R.T., Hanri D., John H.A.
"L. Sacco" Hospital, Urology, Milan, Italy
University Hospital Ztirich, Urology, Zurich, Switzerland
INTRODUCTION & OBJECTIVES: In January 2001 we initiated a laparoscopic radical prostatectomy program, with the collaboration of Tullio Sulser from Swisse. After performing 200 cases according to the classical Montsouris technique, we started an evaluation program of robot-assisted radical prostatectomy using daVinci tm Surgical System. We present a video of our current approach to robot-assisted radical prostatectomy.
INTRODUCTION & OBJECTIVES: Since the laparoscopic approach for radical surgical treatment of localized prostate cancer has emerged, an increasing number of specialized centres report good results with this new technique. More recently robot assisted systems have been introduced to facilitate the techniqually very demanding procedure and may allow an even better visualization of the anatomy and a more precise dissection of vital structures. In our video we show a robot assisted endoscopic extraperitoneal seminal vesical tip and nerve sparing radical prostatectomy as it is performed in our institution.
MATERIAL & METHODS: We use a five-port technique. A U-shaped incision is made on the Douglas pouch and both seminal vesicles and vasa are isolated and prerectal space is developed after the incision of the Denonvillier's fascia. An inverted U-shaped incision is made on the surface of the peritoneum laterally to both the umbilical arteries in order to create subperitoneal space. A bilateral pelvic fascia incision is done and ligation of the dorsal vein complex is completed. The bladder neck dissection and division permits to reach the vasa and the seminal vesicles previously isolated. Both lateral prostatic pedicles are transacted and apical dissection and division of the urethra are performed. The specimen is inserted into the endobag. Bilateral lymphadenectomy is completed and the urethro-vescical anastomosis is performed by single stitches. RESULTS: We performed the comparison of our first ten robot-assisted radical prostatectomy (R-ARP) with our first ten laparoscopic radical prostatectomy (LRP). The mean operative time was 246 rain. for R-ARP vs. 320 min. for LRP, the mean blood loss was 110 cc for R-ARP vs. 515 cc for LRP and the mean hospitalization was 4.8 days for R-ARP vs. 6.5 days for LRP.
MATERIAL & METHODS: Since September 2002 we performed 120 robot assisted laparoscopic radical prostatectomies using a daVinci robotic system. We initially adopted the Montsouris technique and in 44 of the most recent 45 procedures we used an extrapertioneal approach. With growing experience slight modifications have constantly been made to optimize our surgical technique. The seminal vesical tips as well as the neurovascular bundles were spared when this was oncologically acceptable. RESULTS: Mean operative time including installation of the robotic system was 250 minutes. No procedure had to be converted to open surgery. Our early oncological results are comparable to the results that are known from large series of open retropubic radical prostatectomies. However, in regard to blood loss, postoperative pain and hospital stay the endoscopic approach is superior to open surgery.
CONCLUSIONS: In an experienced centre in laparoscopic surgery, the learning curve of robotic radical prostatectomy is extremely short and blood loss and hospitalization are extremely favourable.
CONCLUSIONS: As shown in our video, the robot assisted endoscopic extraperitoneal approach allows a very precise anatomical prostatectorny. It offers patients the benefits of minimal invasive surgery without compromising oncological or functional results.
LAPAROSCOPIC CYSTECTOMY FOR BLADDER CANCER: DESCRIP-
LAPAROSCOPIC CYSTOPROSTATECTOMY
V8 TION STEP BY STEP Cathelineau X., Rozet E, Lorin S., Duncan W., Arroyo C., Barret E. Vaessen C., Mouzin M., Game X., Berrogain N., Malavaud B., Rischmann P. Institut Montsouris, Paris, France CHU Rangueil, Department of Urology, Toulouse, France INTRODUCTION & OBJECTIVES: Radical eystoprostatectomy is the gold INTRODUCTION & OBJECTIVES: Laparoscopie cysteetomies have been recently described but still under evaluation. This movie shows with precision the different steps for a safe, bloodless and carcinologic cystectomy.
standard treatment for invasive bladder tumours. The laparoseopic approach is currently being evaluated worldwide. We report the surgical technique of laparoseopic radical cystoprostatectomy and Bricker urinary diversion by a small midline incision that is used to remove the surgical specimen.
MATERIAL & METHODS: The opening of the peritoneum is shown as well as the dissection of the seminal vesicles, vas deferens, ureters, bladder and prostatic pedicles. It also shows the topographic relations between those elements. The continent bladder reconstruction is done through a small sub-umbilical
MATERIAL & METHODS: Between May 2001 and May 2004, we performed 70 laparoscopie cystectomies (including cystoprostateetomy, prostate sparing cystectomy and anterior pelvectomy) for bladder cancer. This video exemplifies the different surgical steps of the laparoscopic cystoprostatectomy.
incision and nreteral re-implantations are realized extra-corporeally. The neobladder anastomose to the ttrethra is done by laparoscopy.
RESULTS: A total of 26 cystoprostatectornies with Bricker urinary diversion
have been performed with a median operating time of 239 minutes (180-340), and RESULTS:
17 patients have been operated on with this technique.
median blood loss was 740 ml (100-1900). There have been no conversions to
Mean operative time was 6.6 +/- 1.8 hours and blood loss was 427 +/- 249 mI.
open, no major complications, or reoperations. The postoperative complications
Hospital stay was 14.2 +/- 3.5 days.
include 2 patients with a pelvic hematoma. The pathology results showed negative margins and there have been no trocar site seeding.
CONCLUSIONS:
In those groups trained in laparoscopic procedures,
laparoscopic radical cysteetomy is a safe option, associated with shorter hospital
CONCLUSIONS: Laparoscopic cystoprostatectomy with Bricker urinary
stays and gentler postoperative recovery. Longer follow up will be request for
diversion is feasible with little morbidity. Long term" follow-up is needed to
carcinologic evaluation.
confirm the oncologic results.
European Urology Supplements 4 (2005) No. 3, pp. 273