V373 ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA USING AN INVERTED T SHAPE INCISION

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V373 ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA USING AN INVERTED T SHAPE INCISION Anuar Mitre, Antonio C. de Lima, Flavio Trigo Rocha, Gustavo Ebaid, and Rafael Coelho Anuar MitreAnuar Mitre Sao Paulo, Brazil More articles by this author , Antonio C. de LimaAntonio C. de Lima Sao Paulo, Brazil More articles by this author , Flavio Trigo RochaFlavio Trigo Rocha Sao Paulo, Brazil More articles by this author , Gustavo EbaidGustavo Ebaid Sao Paulo, Brazil More articles by this author , and Rafael CoelhoRafael Coelho Celebration, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.460AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the increasing popularity of endourological techniques for treatment of BPH, open simple prostatectomy (OSP) remains the procedure of choice for prostatic adenomas too large for a safe endoscopic resection. Nevertheless, OSP has been associated with significant perioperative morbidity. Simple laparoscopic or robotic prostatectomy may be an alternative to open simple prostatectomy with potentially lower morbidity, lower blood loss, faster recovery, shorter hospital stay, and earlier return to normal activities. During laparoscopic or robotic assisted simple prostatectomy the hyperplasic prostatic tissue may be approached by: 1. a transverse capsular incision as proposed by Millin, 2. longitudinal transvesico-capsular incision as proposed by Mariano, or 3. Transverse vesical incision proposed by Sotelo. METHODS In this video we describe our technique of Robotic- Assisted Simple Prostatectomy. We propose to approach the prostatic adenoma with a transversal vesical incision just proximal to the bladder neck. When it becomes necessary, the prostatic capsule can be further incised longitudinally, in order to obtain a better visualization of the apical area, while avoiding exaggerated traction during the dissection. The capsule flaps can also fixed with separate stitches to the Cooper ligament, maximizing the exposure. RESULTS The patient presented in this video is 65 years old male with long term history of BPH and one prior episode of acute urinary retention. Transrectal ultrasound guided biopsy revealed prostatic volume of 200cm3 and benign prostatic hyperplasia. The patient underwent robotic assisted simple prostatectomy. Operative time was 160 minutes and EBL 300cc. No perioperative or postoperative complications were observed. The prostate specimen weighted 150gm. Significant improvement in lower urinary tract symptoms was reported by the patient after surgery (IPSS preoperative vs postoperative, 32 vs 8). CONCLUSIONS The transverse vesical incision offers very good visualization of the trigone and ureteral orifices during robotic or laparoscopic simple prostatectomy; nevertheless, the addition of a longitudinal capsular incision may offer improved exposure of the prostatic apex, especially for patients with very large prostatic adenomas. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e151-e152 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anuar Mitre Sao Paulo, Brazil More articles by this author Antonio C. de Lima Sao Paulo, Brazil More articles by this author Flavio Trigo Rocha Sao Paulo, Brazil More articles by this author Gustavo Ebaid Sao Paulo, Brazil More articles by this author Rafael Coelho Celebration, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...