PD43-06 IMPACT OF PROSTATIC SHAPE ON THE DIFFICULTY OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-06 IMPACT OF PROSTATIC SHAPE ON THE DIFFICULTY OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Ken Kamisawa*, Kazuhiro Matsumoto, Toshikazu Takeda, Kimiharu Takamatsu, Yota Yasumizu, Nobuyuki Tanaka, Shinya Morita, Takeo Kosaka, Ryuichi Mizuno, Hiroshi Asanuma, and Mototsugu Oya Ken Kamisawa*Ken Kamisawa* More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Toshikazu TakedaToshikazu Takeda More articles by this author , Kimiharu TakamatsuKimiharu Takamatsu More articles by this author , Yota YasumizuYota Yasumizu More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Shinya MoritaShinya Morita More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Hiroshi AsanumaHiroshi Asanuma More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted laparoscopic radical prostatectomy (RALP) is a valuable treatment option for clinically localized prostate cancer . However, RALP for larger prostates is associated with greater blood loss and longer operative times. Meanwhile, there are sometimes easy cases with large prostates, and vice versa. Therefore, we focused the impact of prostatic shape on the surgical difficulty. We hypothesized that RALP for spherical prostates is more difficult than non-spherical ones. METHODS: We retrospectively reviewed 211 patients who underwent RALP between 2017 and 2019, excluding those who received neoadjuvant therapy. All surgeries were performed by two surgeons, each of whom had performed more than 50 RALP procedures by 2017. Patient age, prostate volume, prostate sphericity, nerve-sparing procedure, and extent of lymphadenectomy were assessed. Prostate sphericity was evaluated by “the roundness” of the prostate, which was defined as a ratio of the radius of the inscribed and circumcircle that share the same center at the largest axial slice by MRI. The console time (CT) was employed as an objective index for the surgical difficulty. RESULTS: The mean patient age was 67 years old (range 45 to 78). The mean prostate volume was 34 cc (range 14 to 88) and mean prostate roundness was 0.55 (range 0.24 to 0.90). Bilateral and unilateral nerve-sparing procedures were performed for 11 (5%) and 47 (22%) cases. The extent of lymphadenectomy was "limited" in 98 (46%) and "standard" in 90 (43%) patients. The mean CT was 194 minutes (range 95 to 296). We found no significant difference in CT regarding the nerve-sparing procedure or extent of lymphadenectomy. Prostate volume and roundness (Figure 1a) were positively correlated with the CT. Furthermore, subgroup analysis with 56 patients with a large prostate volume (> 40cc) revealed that prostate roundness was comparatively strongly correlated with the CT (Figure 1b). CONCLUSIONS: This study demonstrated that the spherical shape of the prostate affects the difficulty of RALP, especially in patients with a large prostate. These results suggested that RALP for large and spherical prostates requires advanced surgical techniques. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e902-e902 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ken Kamisawa* More articles by this author Kazuhiro Matsumoto More articles by this author Toshikazu Takeda More articles by this author Kimiharu Takamatsu More articles by this author Yota Yasumizu More articles by this author Nobuyuki Tanaka More articles by this author Shinya Morita More articles by this author Takeo Kosaka More articles by this author Ryuichi Mizuno More articles by this author Hiroshi Asanuma More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement PDF downloadLoading ...