Commentary on “Applicability of robot-assisted laparoscopic radical prostatectomy in renal allograft recipients.” Wagener N, Nyarangi-Dix JN, Teber D, Zeier M, Hohenfellner M, Department of Urology, University of Heidelberg, Heidelberg, Germany: Transplant Proc 2012; 44(5):1287–92

Abstract

PurposeTo evaluate the general applicability of robotic-assisted laparoscopic radical prostatectomy (RALP) in renal transplant recipients and potential surgical modifications due to the position of the transplanted kidney in the iliac fossa, as RALP has proven to be an effective and safe treatment option for prostate cancer (PCa) removal. ProceduresA 71-year-old patient who had undergone renal transplantation was diagnosed with biopsy-proven localized Gleason 7a PCa. The prostate-specific antigen value was 12.4ng/mL. RALP was performed by a transperitoneal approach using six ports. By partial mobilization of the bladder, the working space for the radical prostatectomy was created, while leaving the renal transplant and ureter untouched. Lymph node dissection was performed only on the contralateral side of the transplanted kidney. ResultsThe procedure concluded after 220 minutes and the estimated blood loss was 300mL. The perioperative clinical course was uneventful. The kidney function remained normal with a creatinine value of 1.2mg/dL. A complete extirpation of the prostate with negative surgical margins was achieved. After catheter removal, the patient was completely continent. ConclusionsRALP in renal transplant recipients is feasible and can be achieved with favorable oncological and functional outcome. No modifications to the standard RALP technique are required in these patients, except from a partial dissection of the bladder from the abdominal wall and a one-sided lymph node dissection.