Yonsei Med J.  2007 Apr;48(2):341-346. 10.3349/ymj.2007.48.2.341.

Robot-Assisted Laparoscopic Radical Prostatectomy: Four Cases

• Lee YS
• Han WK
• Oh YT
• Choi YD
• Yang SC
• Rha KH

• KMID: 1779543
• DOI: http://doi.org/10.3349/ymj.2007.48.2.341

Abstract

The role of the da Vinci(TM) robot is being defined in minimally invasive urologic surgery. Robot-assisted laparoscopic radical prostatectomy (rLRP) has emerged as a feasible treatment option for patients with organ-confined prostate cancer. We performed the first four rLRPs on four prostate cancer patients in the Republic of Korea. This is a report of its techniques and outcomes. In all four cases, the surgery was successfully completed with a mean operative time of 392.5 minutes. The mean estimated blood loss was 312.5mL, and catheterization lasted 14 to 21 days. There were no major intraoperative or postoperative complications. The mean hospital stay was 11 days. The rLRP is a safe and feasible approach. It will become one of the standard options for the management of localized prostate cancer.

Keyword

Robot; laparoscopy; prostatectomy

MeSH Terms

*Robotics
Prostatectomy/*methods
Prostate-Specific Antigen/blood
Middle Aged
Male
Laparoscopy/*methods
Korea
Humans
Blood Loss, Surgical
Aged

Figure

• 

  Fig. 1 Port placement: 12-mm robot camera port [A]; 8-mm robot arm port for monopolar, bipolar instruments [B,C]; 12-mm first assistant non-dominant hand port [D]; 5-mm first assistant dominant hand port [E]; and 5-mm second assistant hand port [F].

• 

  Fig. 2 View of peritoneoscopy carried out with a 00 laparoscope.

• 

  Fig. 3 Bladder neck dissection. (A) divided anterior bladder neck. (B) posterior bladder neck dissection.

• 

  Fig. 4 Urethrovesical anastomosis. (A) a single suture by tying the tails of two 3-0 monocryl sutures, (B) suturing on right semicircle with 3-0 monocryl.

Reference

1. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol. 1998. 160(6 Pt 2):2418–2424.

2. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997. 50:854–857.

3. Abbou CC, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F, et al. Laparoscopic radical prostatectomy: preliminary results. Urology. 2000. 55:630–634.

4. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol. 2001. 166:2101–2108.

5. Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute. J Urol. 2003. 169:1261–1266.

6. Gill IS, Zippe CD. Laparoscopic radical prostatectomy: technique. Urol Clin North Am. 2001. 28:423–436.

7. Hemal AK, Srinivas M, Charles AR. Ergonomic problems associated with laparoscopy. J Endourol. 2001. 15:499–503.

8. Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A. Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascial sparing techniques. J Urol. 2005. 174:2291–2296.

9. Kaul S, Bhandari A, Hemal A, Savera A, Shrivastava A, Menon M. Robotic radical prostatectomy with preservation of the prostatic fascia: a feasible study. Urology. 2005. 66:1261–1265.

10. Menon M, Hemal AK, Tewari A, Shrivastava A, Bhandari A. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy. BJU Int. 2004. 93:715–719.

11. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR. Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology. 2002. 60:39–45.

12. Menon M. Robotic radical retropubic prostatectomy. BJU Int. 2003. 91:175–176.

13. Tewari A, Srivasatava A, Menon M; Members of the VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003. 92:205–210.

14. Menon M, Shrivastava A, Sarle R, Hemal A, Tewari A. Vattikuti Institute prostatectomy: a single-team experience of 100 cases. J Endourol. 2003. 17:785–790.

15. Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, et al. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003. 43:444–454.

16. Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003. 170:1738–1741.

17. Perer E, Lee DI, Ahlering T, Clayman RV. Robotic revelation: laparoscopic radical prostatectomy by a nonlaparoscopic surgeon. J Am Coll Surg. 2003. 197:693–696.