Robot-assisted Placement of Pelvic Tissue Expander for Radiation After Prostatectomy and Cystectomy for Treatment of Prostate Cancer Biochemical Recurrence

Abstract

ObjectiveTo present a robot-assisted surgical technique for overcoming challenges of a patient with prior pelvic surgeries and bowel in the radiation target. MethodsA 72-year-old male required treatment for biochemically recurrent prostate cancer. In 2006, he presented with Prostate-Specific Antigen (PSA) 5.74 ng/mL, Gleason 3 + 3 prostate cancer. He underwent a robot-assisted radical prostatectomy for pT2aNx adenocarcinoma with negative margins. In 2008, he was found to have muscle-invasive high-grade papillary urothelial carcinoma and underwent robot-assisted radical cystectomy and ileal conduit for pT2bN0 urothelial carcinoma. In 2017, he had prostate cancer biochemical recurrence, with a PSA of 0.27 ng/mL. Pelvic CT showed small bowel in his prostatic bed behind the pubic bone. A robot-assisted lysis of adhesions and placement of a tissue expander in the prostatic fossa was performed. Three robotic ports and 1 assistant port were utilized. The sigmoid and small bowel were displaced during lysis of adhesions. The deflated tissue expander was inserted through the midline trocar site, inflated intra-abdominally, and filled with 330 cc of saline. The tissue expander was secured with proline sutures in a dependent position. The patient subsequently underwent Intensity-modulated radiation therapy of 66 Gy to the prostatic fossa. Eleven days after finishing intensity-modulated radiation therapy, he underwent successful laparoscopic removal of the tissue expander. PSA nadir was <0.02 ng/mL. ResultsThe patient tolerated intensity-modulated radiation therapy without complications. There were no gastrointestinal complaints following radiation therapy. ConclusionRobotic placement of a tissue expander in patients who have undergone multiple pelvic surgeries is feasible and may reduce radiation morbidity.