Descriptive Technique and Initial Results for Robotic Radical Perineal Prostatectomy

Kaouk, Jihad; Akça, Oktay; Zargar, Homayoun; Caputo, Peter A.; Ramírez, Daniel; Andrade, Hiury; Albayrak, Selami; Laydner, Humberto; Angermeier, Kenneth W.

doi:10.1016/j.urology.2016.02.063

Cited by 55 publications

(27 citation statements)

References 43 publications

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“…All surgeries were performed by a single surgeon (V.T. ), who has sufficient experience both in RPP and RARP (>20 cases of RPP under supervision of a surgeon with significant experience with open RPP, and >1500 RARP cases), using the technique previously described by Kaouk et al [11] Bilateral nerve-sparing surgery was applied in all patients with preoperative erectile potency, provided a nerve-sparing approach was not contraindicated (preoperative PSA level ≤15 ng/mL).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Robot‐assisted radical perineal prostatectomy: a review of 95 cases

et al. 2020

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Objectives To assess the early functional and oncological outcomes of a large series of patients who underwent robot‐assisted radical perineal prostatectomy (RPP). Materials and Methods We retrospectively analysed the patients who underwent robot‐assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow‐up times were recorded. Results A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate‐specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow‐up time was 13 (3.1) months. Conclusion We conclude that robot‐assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

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Section: Surgical Proceduresmentioning

confidence: 99%

Robot‐assisted radical perineal prostatectomy: a review of 95 cases

et al. 2020

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“…In the new surgical era, perineal prostatectomy has regained public attention after the promotion of da Vinci robotic surgery and single-port laparoscopic innovations. The concept of robotic PRP (RPRP) was first reported by Kaouk et al [5] and was deemed a safe and feasible procedure. Tuğcu et al [6] reported perineal access for pelvic lymph node dissection (PLND), and a retrospective matched analysis from the same institution further investigated the potential superiority of RPRP due to the reduced operative time and blood loss, the shorter postoperative recovery time, and better short-term quality-of life outcomes [7].…”

Section: Introductionmentioning

confidence: 99%

Robotic Perineal Radical Prostatectomy: Initial Experience with the da Vinci Si Robotic System

Chang

et al. 2020

Urol Int

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To investigate the feasibility and surgical technique of robotic perineal radical prostatectomy (RPRP). Materials and Methods: We retrospectively analyzed 6 consecutive patients diagnosed with prostate cancer from December 2018 to May 2019 who underwent RPRP at our center. Perioperative outcomes were recorded for safety and feasibility analysis. Results: Six patients successfully underwent RPRP with no conversion to open procedures. Operative time was 140 (interquartile range [IQR] 123.75-148.75) min, console time was 70 (IQR 62.5-70) min, with an estimated blood loss of 125 (IQR 100-187.5) mL. Patients were discharged 2 days postoperatively (IQR range 1-3) with pelvic drainages removed. The Foley catheter was removed 2 weeks after surgery. Postoperative pathology revealed 5 patients with locally advanced disease (apical margin-positive prostate cancer [pT3a]bNx). Two patients had a positive surgical margin (33.3%). No complications of Clavien grade 3 and above were recorded; 1 patient had a delay in woundhealing of 1 week. Postoperative continence was achieved for 2 patients immediately after Foley catheter removal, 2 recovered 1-month postoperatively, and 1 recovered within 3 months, and 1 still had mild incontinence at the latest follow-up 1-month postoperatively. Conclusion: RPRP is a safe and feasible alternative for the transperitoneal route in selected patients. Further investigation is required to assess its oncological and quality-of-life results.

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“…Kaouk et al [12] from Cleveland Clinic, USA, defined the first technique of robot-assisted radical perineal prostatectomy (r-RPP). They experimentally tested this model on cadavers.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted radical perineal prostatectomy: first experience of 15 cases

Tuğcu

Akça

Şimşek

et al. 2017

Turkish Journal of Urology

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Objective: Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot-assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP. Material and methods:Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT ® device was placed and robotic system was docked. Results:The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m 2 . Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients. Conclusion:We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area.

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Descriptive Technique and Initial Results for Robotic Radical Perineal Prostatectomy

Cited by 55 publications

References 43 publications

Robot‐assisted radical perineal prostatectomy: a review of 95 cases

Robot‐assisted radical perineal prostatectomy: a review of 95 cases

Robotic Perineal Radical Prostatectomy: Initial Experience with the da Vinci Si Robotic System

Robot-assisted radical perineal prostatectomy: first experience of 15 cases

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