V1228 BEHIND THE STAGE: LAPAROSCOPIC VIEW OF RETROPUBIC AREA DURING RADICAL PERINEAL PROSTATECTOMY

Abstract

cation to include complex cases such as nerve-sparing radical prostatectomy. We present our experience with athermal nerve-sparing RLESS radical prostatectomy and describe our technique. METHODS: Between May 2008 and May 2010. A total of 20 R-LESS radical prostatectomies were performed, including 3 using an athermal nerve-sparing technique. We demonstrate the steps of this procedure in video format including: 1) Placement of the single port access device, 2) Description of necessary equipment 3) Mobilization of the bladder 4) Incision of the endopelvic fascia 5) Ligation of the dorsal venous complex 6) Dissection of the bladder neck 7) Dissection of the seminal vesicles 8) Control of the vascular pedicles 9) Antegrade dissection of the neurovascular bundles from the prostate, 10) Antegrade dissection of the prostate from the rectum 11) Transection of the dorsal venous complex and urethra 12) Entrapment of the prostate, and 13) Vesico-urethral anastamosis. Additionally we present our cumulative outcomes including: demographics, perioperative data, pathology, margin status, postoperative SHIM score, and continence rates. RESULTS: All three athermal nerve-sparing R-LESS radical prostatectomies were performed without the addition of extra ports. Demographics and postoperative outcomes are seen in the table. The mean operative time was 170 minutes and estimated blood loss was 100ml. Visual analogue pain scale scores was 1/10. Mean follow up was 6 months. CONCLUSIONS: Robotic laparoendoscopic single-site surgery continues to evolve and with refinements, complex procedures such as athermal nerve-sparing radical prostatectomy are possible. Our early results are promising but prospective comparisons to standard nervesparing RALP are needed.