V14-11 TRANSVESICAL ROBOT ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-11 TRANSVESICAL ROBOT ASSISTED RADICAL PROSTATECTOMY Gongxian Wang*, Xiaochen Zhou, Bin Fu, and Cheng Zhang Gongxian Wang*Gongxian Wang* More articles by this author , Xiaochen ZhouXiaochen Zhou More articles by this author , Bin FuBin Fu More articles by this author , and Cheng ZhangCheng Zhang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To introduce the technique and report our initial experience of transvesical robot assisted radical prostatectomy (TvRARP). METHODS: 35 TvRARP for prostate cancer performed by a single surgical team between 2018 April and 2019 April were retrospectively reviewed. Preoperative data of patients [patient age (63.4, [49-73]) years, BMI (28.6 [22.1-35.4]) kg/m2, tPSA (10.8 [4.6-19.5]) ng/ml, biopsy Gleason score 6 (6∼7), prostate volume (30.6 [15.4-61.2]) ml and IIEF-5 score 15 (10∼20)] were collected. Preoperative study revealed 28 cases of cT2a and 7 case of cT2b. All patients were continent preoperatively. Surgical techniques: The surgery was performed with da Vinci Si system via 4 robotic ports and 2 assistant ports as the following: 1) cystotomy, further expended by bilateral suspension stitches. 2) A circumferential incision is made around the internal urethral orifice through the mucosa and muscular layer. 3) Initial dissection of the vas deferens and semi vesicles is carried out through the lower half of the circumferential incision around the internal urethral orifice. 4) Posterior dissection towards the apex of the prostate. 5) Dissection of bilateral NVB. 6) Anterior dissection towards the apex of the prostate. 7) Dissection and transection of the urethra. 8) Urethrovesical anastomosis. 9) 2-layer closure of bladder. RESULTS: All 35 cases were successfully performed robotically without conversion, transfusion or other major intraoperative and postoperative complications. Postoperative pathology confirmed 24 pT2a cases, 9 pT2b cases and 2 pT2c case [Gleason score 6 (6∼8)]. 4 case reported positive surgical margin (12.5%). Operative time was (130 [90-190]) min. Estimated blood loss was (100 [50-250]) ml. Urethral catheter was removed at postoperative 7-day. 32 patients achieved urinary continence (0 pads) immediately after the removal of urinary catheter, while 3 patient returned to full continence in 2 weeks postoperatively. During a mean follow up of 12 months (6∼18 months), no biochemical recurrence was noted (tPSA<0.2ng/ml). At 2-month postoperatively, IIEF-5 score was 15 (10∼19) and not statistically different from preoperative status (p > 0.05). CONCLUSIONS: Transvesical approach is a valid alternative of performing RARP in patients bearing localized low-risk prostate cancer. Tumor control and preservation of erectile function remains to be determined in long term follow up. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1309-e1309 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gongxian Wang* More articles by this author Xiaochen Zhou More articles by this author Bin Fu More articles by this author Cheng Zhang More articles by this author Expand All Advertisement PDF downloadLoading ...