Extra-peritoneal robot assisted radical prostatectomy revisited (SIU 2011)
- uploaded: Sep 19, 2011
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Institution:All India Institute of Medical Sciences, New Dehli, India
Introduction and objectives:
Robot assisted laparoscopic prostatectomy is being increasingly performed via the transperitoneal route. The extraperitoneal approach has been deemed to be more technically challenging in view of the limited working space. Herein we report our initial experience with the extraperitoneal approach.
Material and Methods
13 patients underwent robot assisted extraperitoneal laparoscopic prostatectomy. The mean age was 68.33 years. The median PSA was 6.5. Five patients had history of previous TURP and one patient had undergone a laparoscopic cholecystectomy in the past. All procedures were performed with the da-Vinci S surgical system. A five port technique was used. Patients were placed supine with 200 Trendelenburg tilt. A 1.5 cm transverse incision was given at the level of the umbilicus. The extraperitoneal space was developed behind the posterior rectus sheath first by blunt finger dissection and later by balloon inflation. A 12 mm camera was placed through this port followed by the insertion of 8mm robotic ports (8cm from the camera port) along the spino-umbilical line and the right and left hand assistant ports (12mm and 5mm respectively) just above the anterior superior iliac spines on either side. After incision of the endopelvic fascia and ligation of the DVC complex, the rest of the procedure proceeded along the lines of the transperitoneal approach. Pelvic lymphadenectomy was performed in one patient who had a biopsy gleason score of 4+4 and PSA value of 42ng/ml.
The mean time required for creation of the extraperitoneal space was 12 mins. The mean console time was 88 min. The mean estimated blood loss was 75ml. None of the patients required blood transfusion. Soft diet was started 6 hours after surgery and patients were ambulatory from the evening of the surgery. The drain was removed on the morning of the first post-operative day in all patients.
For surgeons well versed in the transperitoneal approach the extraperitoneal route is the logical next step to minimize the invasiveness of the robotic approach further by avoiding peritoneal violation. This most closely mimics the traditional open approach and is both safe and feasible.
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