Robot-Assisted Laparoscopic Radical Prostatectomy in Patients with Previous Abdominal Surgery: A Novel Laparoscopic Adhesiolysis Technique

Abstract

We evaluated the feasibility and outcomes of performing a novel laparoscopic adhesiolysis technique before robot-assisted laparoscopic radical prostatectomy (RALRP) in patients with previous abdominal surgery. A total of 18 men with incision scars from previous abdominal surgeries underwent RALRP. A 12-mm trocar was placed at the lateral lower quadrant away from the incision site, and a teaching laparoscope was introduced into the peritoneal cavity. Meticulous adhesiolysis was performed through a single trocar to subsequently allow safe placement of additional robotic trocars. Age, type of previous surgery, total operative time, console time, anastomosis time, estimated blood loss, transfusion rate, complications, and conversion rate were recorded. All patients had multiple abdominal surgeries. Mean operative time was 297 minutes, mean console time was 194 minutes, and mean estimated blood loss was 241 mL. No access-related complication and no conversion to open surgery occurred. This novel laparoscopic technique of adhesiolysis with a teaching laparoscope through a single trocar facilitates safe placement of trocars and accomplishment of RALRP in patients with previous abdominal surgery.