V8-12 COMBINING ANTEGRADE AND RETROGRADE DISSECTION DURING SALVAGE ROBOTIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate and Renal Oncology1 Apr 2017V8-12 COMBINING ANTEGRADE AND RETROGRADE DISSECTION DURING SALVAGE ROBOTIC RADICAL PROSTATECTOMY Mariaconsiglia Ferriero, Giuseppe Simone, Riccardo Mastroianni, Gabriele Tuderti, Leonardo Misuraca, Francesco Minisola, Salvatore Guaglianone, and Michele Gallucci Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Francesco MinisolaFrancesco Minisola More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2348AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently published series of salvage robotic radical prostatectomy for radiorecurrent prostate cancer showed the feasibility and the safety of this complex surgical procedure with favorable perioperative and satisfactory functional outcomes. This video shows surgical steps of a salvage robotic radical prostatectomy with pelvic lymph node dissection for radio recurrent prostate cancer. METHODS We present a case of a 60 yr old patient who underwent primary radiation therapy in 2007 for a G7(3+4) prostate cancer. Due to a raising PSA, a prostate biopsy showed a G7(4+3) prostate cancer of the right lobe. A 18F Choline PET/CT was negative for nodal and distant metastasis. With the patient in a steep trendelenburg position a five trocar access was performed. Bilateral extended pelvic lymph node dissection was completed. The Retzius space was developed and the endopelvic fascia bilaterally incised. After sealing the dorsal vein complex with Ligasure, urethral stump was meticulously prepared and transected. The apex was retrogradely dissected up to identifying the Denonvilliers fascia, before moving to bladder neck isolation. Bladder neck was isolated and sectioned and seminal vesicles dissected. The Denonvilliers fascia was identified and opened and the dissection plane, previously prepared retrogradely, was identified. Bilateral extrafascial radical prostatectomy was completed. A Van Velthoven anastomosis with posterior muscolo-fascial reconstruction was performed. RESULTS Operative time was 132 minutes. Blood loss was 300 ml. Postoperative course was uneventful and the patient was discharged on 3rd postoperative day. Pathologic examination showed a pT2bN0 G7(4+3) prostate cancer with negative surgical margins. One-mo PSA levels were 0.01 ng/mL. At 6 month follow up PSA level remained 0 and patient was continent. CONCLUSIONS Combining retrograde and antegrade dissections during salvage robotic radical prostatectomy may contribute to a safe development of the posterior dissection plane. Salvage robot assisted radical prostatectomy is a feasible treatment option for patients with radiorecurrent prostate cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e910 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mariaconsiglia Ferriero More articles by this author Giuseppe Simone More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Leonardo Misuraca More articles by this author Francesco Minisola More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...