Korean J Urol.  2006 Feb;47(2):206-210. 10.4111/kju.2006.47.2.206.

Robot-assisted Laparoscopic Radical Prostatectomy

• Lee YS
• Han WK
• Yang SC
• Rha KH

• KMID: 2294203
• DOI: http://doi.org/10.4111/kju.2006.47.2.206

Abstract

In recent years, robot-assisted laparoscopic radical prostatectomy (rLRP) has emerged as a feasible treatment option for patients with organ-confined prostate cancer. We first performed rLRP in the republic of Korea and report our technique and outcome. Our patient was a 69-year-old man presenting with a T1a adenocarcinoma, a 4(2+2) Gleason score and 1.37ng/ml preoperative serum prostate specific antigen. A rLRP was performed with the da Vinci(TM) robot system (Intuitive Surgical, Inc., Mountain View, USA) which has a total of seven degrees of motion (six degrees of freedom and grip) EndoWrist instrumentation. The total operative time was 420 minutes, and the robot set-up time including port insertion was 80 minutes. The estimated blood loss was 200ml. The pathological examination showed a stage T2a, with a 4(2+2) Gleason score and negative surgical margins. A rLRP confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

Keyword

Robotics; Laparoscopy; Prostatectomy

MeSH Terms

Adenocarcinoma
Aged
Freedom
Humans
Laparoscopy
Neoplasm Grading
Operative Time
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms
Republic of Korea
Robotics
Prostate-Specific Antigen

Figure

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  Fig. 1 Port placement: 12mm robotic camera port (A): an 8mm robotic arm port for the monopolar, bipolar instrument (B, C): a 12mm assistant nondominant hand port (D): and a 5mm assistant dominant hand port (E).

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  Fig. 2 Surgical console: (A) view of operator performing rLRP while sitting at the surgical console, (B) view of using the EndoWrist. rLRP: robot- assisted laparoscopic radical prostatectomy.

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

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

Reference

1. 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.

2. Rha KH, Kim JH, Kim YS. Initial experience of laparoscopic radical prostatectomy. Abstracts of the 2005 spring meeting of the Korean Prostate Society. 2005. Daegu, Korea. –86.

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

4. Menon M, Hemal AK. VIP team. Vattikuti Institute prostatectomy: a technique of robotic radical prostatectomy: experience on more than 1,000 cases. J Endourol. 2004. 18:611–619.

5. Lee DI, Eichel L, Skarecky DW, Ahlering TE. Robotic laparoscopic radical prostatectomy with a single assistant. Urology. 2004. 63:1172–1175.

6. 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.

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

8. Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol. 2003. 44:175–181.

9. 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.

10. Sarle R, Tewari A, Shrivastava A, Peabody J, Menon M. Surgical robotics and laparoscopic training drills. J Endourol. 2004. 18:63–66.