A safe teaching protocol of LRP (Laparoscopic Radical Prostatectomy)

Tobias-Machado, Marcos; Pazeto, Cristiano Linck; Neves-Neto, Oseas Castro; Nunes‐Silva, Igor; Zampolli, Hamilton de Campos

doi:10.1590/s1677-5538.ibju.2017.0137

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Nearly 80% of the affected patients suffered from symptoms ranging from irritative to obstructive symptoms with associated hematuria, which comes in line with the clinical presentation of our case [11]. On the other hand, other patients were rarely asymptomatic [12]. Although bladder leiomyoma has benign nature, it may behave as a malignant tumor, thus surgical removal using different surgical approaches is often preferred [11].…”

Section: Discussionsupporting

confidence: 81%

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Ali,

Wilby,

Dossantos

et al. 2023

UTJ

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Leiomyoma of the urinary bladder is uncommon benign tumor with a wide range of clinical presentations. Surgical excision remains the definitive treatment of leiomyoma with excellent outcomes. Seldom literatures reported the use of robotic-assisted surgical techniques for its excision. A 51-year-old woman presented with frequent episodes of visible hematuria in consistence with lower urinary tract symptoms. The initial diagnosis was a urinary tract infection. However, symptoms did not resolve even with the proper antibiotics. After further investigations a soft tissue density mass measuring 20 × 23 × 20 mm within the left posterior wall of the urinary bladder extending towards the bladder neck was found. The histological finding of the transurethral resected biopsy of the mass revealed a benign submucosal leiomyoma of the bladder with no evidence of any malignancy. Using the Intuitive Da Vinci X system the tumor was excised using the ultrasound guidance to define the tumour margins, sparing the left ureteric orifice and ureter. The patient was discharged home on the day of surgery, with a urethral catheter in place. The catheter was successfully removed after 10 days, with cystogram prior confirming no leakage. The ureteric stent was removed by flexible cystoscopy two weeks later. The final histology was reported as a bladder leiomyoma with no evidence of malignant features and negative circumferential resection margins. Herein, in the current case we present a safe and effective technique for the excision of recurrent bladder leiomyoma using the robotic-assisted transvesical approach with intraoperative ultrasound guidance.

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Section: Discussionsupporting

confidence: 81%

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Ali,

Wilby,

Dossantos

et al. 2023

UTJ

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“…Mixter forceps were passed posterior to the DVC, which was transected with a 15-blade knife. The DVC was ligated upfront in a RP and subsequently transected before dissection of the prostate (5,10), but in laparoscopic surgery the majority of procedures follow ligation of the DVC, resection of the prostate except the apex, transection with or without reconstruction of the bladder neck of the DVC, separation of the apex, and division of the urethra (4).…”

Section: Discussionmentioning

confidence: 99%

“…The pre-prostate fat was dissected during an eLRP and sent for pathologic evaluation. After excision of the pre-prostatic fat (5) and incision of the pelvic fascia, the pubovesical ligament and DVC were exposed. The preference, but not requirement, was to continue the dissection as close as possible to the DVC-urethral space or the point that the DVC, urethra, and prostate connect.…”

Section: Bts Techniquementioning

confidence: 99%

Beforehand transection and suturing (BTS) of the dorsal vascular complex: a novel technique in laparoscopic radical prostatectomy

et al. 2020

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Background: Beforehand transection and suturing (BTS) of the dorsal vascular complex (DVC), a novel technique in non-neurovascular bundle sparing (NVB-sparing) extraperitoneal laparoscopic radical prostatectomy (eLRP), had been proposed; this study aimed to evaluate this technique in clinical laparoscopic procedures.Methods: Using this new technique, the DVC was transected and sutured after dissection of the pelvic fascia and before dissection of the prostate, especially before ligation of the bilateral prostatic pedicles. This study retrospectively analyzed the data of 90 non NVB-sparing eLRP patients [traditional technique (n=60) and BTS technique (n=30)].Results: The surgical time in the BTS technique group was 121.73±24.53 min, which was significantly shorter (P=0.0015) than the traditional technique group (144.12±39.68 min). The calculated blood loss in the traditional technique group was 388.45±232.78 mL, and 264.16±130.70 mL in the BTS technique group (P=0.0016). The estimated blood loss in the traditional technique group was 350.34±311.80 mL, which was significantly greater than the BTS technique group (250.33±145.31 mL, P=0.0422). The transfusion rate in the traditional technique group was significantly greater than the BTS technique group (15.00% vs. 0.00%; P=0.0266). The biochemical recurrence rate in traditional technique group was 48.33%, which was higher than in the BTS group (30.00%) (P=0.0465). There was no significant difference between the 2 groups with respect to the pre-operative hemoglobin (Hb) concentration, pre-operative hematocrit (HCT), postoperative Hb concentration, post-operative HCT, ΔHCT, pre-operative blood volume, rectal perforation, open conversion, apical capsule residue, false suture, post-operative bleeding, urinary leakage, re-operation, surgical site infection, post-operative stay, and emission time of urinary incontinence. Conclusions:In managing the relationship between the DVC and prostate in patients undergoing non NVB-sparing eLRP, the BTS technique was shown to be more effective and safer than the traditional technique.

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“…Step-wise teaching protocols and formal training, as described in Brazil 29 and Australia 15 , can be used to optimize and abbreviate the learning curve and effectively teach safe and successful LRP with regard to oncology. Along with the growth of the capacity of surgical technique, the perioperative outcomes are upgrading and the hospital stay getting shorter.…”

Section: Figure 1 Operative Time and Estimate Blood Loss Learning Cur...mentioning

confidence: 99%

Laparoscopic Radical Prostatectomy: Single Center Case Series

Penezić

Kuliš

Hudolin

et al. 2022

ACC

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Laparoscopic radical prostatectomy (LRP) is traditionally characterized as a technically difficult procedure with a long learning curve but it is successfully performed worldwide. The aim of this paper was to assess the initial learning curve and clinical outcomes for LRP in our center. We performed a retrospective study including 63 LRP cases, in the course of 22 months, performed by 2 urologists, with no previous LRP experience. All patients were previously assessed by a multidisciplinary team and were selected on the basis of low and intermediate risk disease attributes according to the classification of prostate cancer risk groups of the European Association of Urology. The main outcomes of follow-up are procedure duration, estimated blood loss, complications, positive surgical margins, biochemical relapse and urinary continence. The median follow-up was 19.6 months. The median procedure duration was 196.8 minutes and median blood loss 257.1 mL. Significant decrease in both outcomes was observed when comparing first and last cases in the series. There were 5 (7.9%) Clavien Dindo grade II complications. Undetectable prostate specific antigen (PSA) was observed in 59 (93.6%) patients, and fifty-five patients (87.3%) were continent. Following a methodical learning approach, LRP can be safely mastered with favorable outcomes.

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A safe teaching protocol of LRP (Laparoscopic Radical Prostatectomy)

Cited by 5 publications

References 23 publications

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Beforehand transection and suturing (BTS) of the dorsal vascular complex: a novel technique in laparoscopic radical prostatectomy

Laparoscopic Radical Prostatectomy: Single Center Case Series

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