Endoscopic Radical Prostatectomy Research Articles

The presence of cribriform pattern in prostate biopsy and radical prostatectomy is associated with negative postoperative pathological features.

Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features. In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres. 48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis. The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.

Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

IntroductionRectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140–210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30–60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal

IntroductionRectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Implementation of the concept of conditions of the national cancer institute of USA for integral assessment of results of the modified endoscopic radical prostatectomy in patients with localized prostate cancer in the State Institution «Institute of urolo

The Objective of study is to investigate an integral analysis of the effectiveness of modified endoscopic radical prostatectomy by applying the concept of conditions of the National Cancer Institute of USA (CCNCI USA). Material and methods. A total of 34 patients who had undergone endoscopic radical prostatectomy with a new method of forming a vesico-urethral anastomosis during 2015–2017. The median of follow-up time was 45.5 months (95% CI 43–51). The results were evaluated using the CCNCI USA after 12, 24 and 36 months from the moment of operation. Due to the presence of severe erectile dysfunction before surgery, four patients were excluded from the analysis. According to the CCNCI USA, the following variants of results of radical prostatectomy are provided: optimal condition (continence, preservation of erectile function and biochemical recurrence free); suboptimal condition (urinary incontinence and/or erectile dysfunction with the absence of biochemical recurrence); biochemical recurrence. Results. There were 19 (63.3%) patients in optimal condition after 12 months, 9 (30%) patients remained in suboptimal condition, and 2 (6.7%) had biochemical recurrence. Only 3 (10%) patients had a biochemical recurrence after 24 months, and 20 (66.7%) and 7 (23.3%) were in optimal and suboptimal conditions, respectively. There were 22 (73.3%) patients in optimal condition after 36 months after radical prostatectomy, 4 (13.3%) remained in suboptimal condition, and three-year recurrence-free survival was 86.7%. Conclusions. In sum, 73.3% of patients in the study group had been reached the optimal condition according to the CCNCI USA during the three-year follow up, and the main reason for constanting a suboptimal functional result had been postoperative erectile dysfunction. Modified endoscopic radical prostatectomy demonstrates a comparable indicator of modern foreign sources of three year recurrence-free survival of patients with localized prostate cancer, due to which this technical modification can continue to be widely used in clinical practice.

Extended pelvic lymph node dissection during extraperitoneal laparoscopic or robotic assisted radical prostatectomy

Objective: Extraperitoneal access in endoscopic (laparoscopicic or robotic assisted) radical prostatectomy is a standard approach in the management of prostatic cancer with well-established advantages over transperitoneal access. Still, traditionally, extraperitoneal endoscopic radical prostatectomy (EERP) has been associated with an inability to offer an extended pelvic lymph node dissection (PLND). The former is due to the fact that in the extraperitoneal space, peritoneal folding covers the majority of common iliac vessels and as a result in extraperitoneal PLND, lymph nodes (LNs) located above the bifurcation of common iliac vessels cannot be dissected. We herein present a simple and easy technique to offer an extended PLND during EERP. Methods: After a conventional extraperitoneal PLND, a peritoneal fenestration cranially to extrernal iliac vessels is performed bilaterally exposing the common iliac vessels. Results: Upon peritoneal fenestration, PLND can be continued in a standard fashion as in transperitoneal approach until the uppermost limit of the extended PLND template which is the ureteral crossing over common iliac vessels. Following LN dissection, both peritoneal fenestrations are left open at both sides, as this approach has been found to decrease the incidence of postoperative lymphocele formation. Conclusions: Peritoneal fenestration over common iliac vessels during extraperitoneal PLND is an easy approach that allows surgeon to reach the uppermost limit of extended PLND template. The latter peritoneal dissection is not time consuming and is expected to decrease the morbidity of the operation reducing the incidence of postoperative lymphocele formation.

Negative outcomes of radical prostatectomy in patients with localized prostate cancer: there are a non-genitourinary postoperative complications in the focus

The aim of the study is to research the frequency and structure of non-genitourinary complications in patients with localized prostate cancer (PC) who were undergone retropubic and endoscopic radical prostatectomy in one clinic. Material and methods. The study included 360 patients, who had been undergone radical prostatectomy (RPE) during 2012-2016 in the clinic of the SI “Institute of urology of NAMS Ukraine”. Group 1 included 99 (27,5%) patients after retropubic radical prostatectomy (RPE), and group 2 – 261 (72,5%) patients after endoscopic radical prostatectomy (ERP). Results. Infectious complications were detected in 9 (9,09%) and 23 (8,81%) patients, cardiocerebropulmonary – in 4 (4,04%) and 3 (1,15%), and neurological – in 1 (1,01%) and 3 (1,15%) patients in groups 1 and 2 respectively. Gastrointestinal complications was registered only in 4 (1,53%) patients who have undergone ERP. Complications of the V degree of severity was detected only in the structure of the cardiocerebropulmonary group. It was found that the most diverse and numerical non-genitourinary group was the infectious group, its complications were I–IIIb of degrees of severity by Clavien–Dindo. Conclusions. The complications of the cardiocerebropulmonary group were the only cause of early intra-hospital mortality in patients undergoing radical surgical treatment of localized prostate cancer during a five-year period in a clinic. All cases of gastrointestinal complications in the early postoperative period required surgical correction, however, they occured episodically. Further study requires the correlation of the concomitant presence of histologically verified prostatitis and the emergence of some infectious complications of the RPE, regardless of the concrete methodics of the RPE.

Prostate Imaging Reporting and Data System in prostate cancer staging and planning for radical prostatectomy.

IntroductionThe Prostate Imaging Reporting and Data System (PI-RADS) was mainly developed for the purposes of prostate cancer (PCa) detection. However, its widespread use suggests that it may play a role in a preoperative workup prior to endoscopic radical prostatectomy (ERP).AimTo evaluate the prognostic value of PI-RADS in predicting extraprostatic extension (EPE) and its influence on surgical planning of ERP.Material and methodsThe analysis involved data of 154 consecutive prostate cancer patients, in whom multiparametric 3.0T magnetic resonance imaging (mpMRI) was performed before ERP. Standard descriptive assessment of mpMRI images was compared with the PI-RADS system with respect to prostate cancer staging and subsequent potential surgical template adjustment.ResultsPI-RADS significantly outperformed the standard way of mpMRI reporting in staging (AUC = 0.615 vs. 0.552, p = 0.036) with PI-RADS 5 established as the best threshold. After reevaluation of imaging, the initial surgical plan was modified based on mpMRI in terms of feasibility and extent of neurovascular bundle preservation during ERP on 96 (31.2%) sides, while on the remaining 212 (68.8%) sides the templates were left unchanged. Decisions based on mpMRI were not associated with increased risk of a positive surgical margin (PSM).ConclusionsThe PI-RADS outperforms the standard staging method using mpMRI and may assist the decision-making process regarding the extent of resection during ERP without increasing the risk of PSM.

Can Robot-assisted Radical Prostatectomy Improve Functional Outcomes Compared to Laparoscopic Radical Prostatectomy? Experience at a Laparoscopic Center

Purpose: This study compared the perioperative parameters and early functional outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) at a urological laparoscopic center. Materials and Methods: Between January 2006 and May 2017, 242 patients underwent endoscopic radical prostatectomy (LRP for 208 cases; RARP for 34 cases). Patients who were followed up &gt; 12 months were included in the study. Propensity score-matched groups of patients who underwent LRP or RARP were created based on age, body mass index, history of diabetes mellitus, history of smoking, preoperative prostate-specific antigen level, clinical T status, risk group classification, American Society of Anesthesiologists score, and whether the nerve-sparing technique was performed. Results: There were no significant differences in the blood transfusion rate, surgical margin status, length of stay, catheterization time, or days to oral intake for both procedures. Although RARP is more time-consuming, it provided significant benefits regarding the yield of dissected lymph nodes (19 vs. 9; P &lt; 0.001) and early urinary continence recovery (i.e., continence rates after 1 month [56.2% vs. 21.9%; P = 0.006] and after 3 months [84.4% vs. 53.1%; P = 0.001]). No difference was observed for early complications, although the RARP group had more late complications. Conclusion: Our experience indicated that RARP could provide less blood loss and faster recovery of urinary continence and yield more dissected lymph nodes compared to LRP. Further studies are needed to determine whether the long-term clinical, functional, and oncological outcomes are superior.

215P - Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer following neoadjuvant therapy: A propensity score-matched analysis

215P - Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer following neoadjuvant therapy: A propensity score-matched analysis

Negative Outcomes of Radical Prostatecomy in Patients with Localized Prostate Cancer: There Are a Genitourinary Group of Postoperative Complications in the Focus

The objective: to research the frequency and structure of the complications of the genitourinary group in patients with localized prostate cancer (PC) who were undergone retropubic and endoscopic radical prostatectomy in one clinic.Material and methods. The study included 360 patients, who had been undergone radical prostatectomy (RPE) during 2012–2016 in the clinic of the SI «Institute of Urology of NAMS Ukraine». Group 1 included 99 (27,5%) patients after retropubic radical prostatectomy (RPE), and group 2 – 261 (72,5%) patients after endoscopic radical prostatectomy (ERP).Results. Genitourinary complications were detected in 30 (30,3%) patients in group 1 and in 81 (31,03%) patients in group 2 (p=0,849), and the most frequent of them were leakage of vesico-urethral anastomosis (VUA): at 12 (12,12%) of patients in group 1 and 35 (13,41%) in group 2 (p=0,746). In groups 1 and 2, there were 22 (22,22%) and 62 (23,76%) cases of genitourinary complications complied with the I–II degrees classification of Clavien-Dindo, while 8 (8,08%) and 19 (7,28%) of complications were releted to degrees III–IV respectively. Genitourinary complications of the V degree were not detected in any of the patient groups.Conclusions. The RRP and ERP series show a comparable total number of complications of the genitourinary group with the background of the consistency of the frequency of the occurrence of its components. The recorded genitourinary complications in most cases were according to the I–II degrees of Clavien-Dindo classification. For a more complete description of the negative outcomes of the RPE, further study of other groups of postoperative complications and negative sequelae, is needed.

Influence of experience of endoscopic radical prostatectomy for its results in patients with localized prostate cancer in clinic of SI «Institute of urology of NAMS Ukraine» during the five-year term

The objective: The purpose of our study is to research and compare the results of radical surgical treatment of patients with localized prostate cancer (PC) undergoing endoscopic radical prostatectomy (ERP) at the conditional stages of «implementation» and the «becoming» of these techniques in the clinic.Materials and methods. There were implemented an assessment of the results of treatment of localized PC of 261 patients who had undergone ERP in the clinic of the SI «Institute of Urology of NAMS Ukraine» during 2012–2016 years inclusively. The patients were divided into two groups according to the depersonalized calendar principle. Group 1 included 99 (37,93%) patients who had been performed ERP in the period from 2012 till 2014 years (the conditional stage of ERP «implementation» in the clinic). Group 2 included 162 (62,07%) patients who had been undergone ERP in the period from 2015 till 2016 years (the conditional stage of ERP «becoming» in the clinic). The clinical, laboratory, computational and pathomorphological data for each patient were analyzed. The data were processed using descriptive, parametric and nonparametric statistics (t-test, Mann-Whitey test, χ2 Pearson) and others.Results. Patients in groups 1 and 2 were not significantly different in age (p=0,342), body weight (p=0,839), total PSA before surgical treatment (p=0,464), prostate volume (p=0,507), the presence of middle lobe of prostate more than 1 sm (p=0,882) or postoperative hospital stay (p=0,613). A statistically significant increasing of the number of patients, who had been underwent neoadjuvant therapy before performing ERP, were revealed in group1 in relation to group 2 (p=0,012). Frequency of haemotransfusions was 17,17% vs 6,79%, the volume of intraoperative blood loss was 500 [235; 800] vs 250 [150; 400] ml, median time for catheterization of the bladder was 12 [9; 15] vs 11 [8; 14] days and ΔHb was -24 [-33; -14] vs ‑19 [-28, 25; -11] g/l in group 1 vs 2, accordingly. There were 69 complications in group 1 of 38 (38,38%) patients and 75 complications in group 2 of 56 (34,57%) patients. Genitourinary complications were prevalented in both cohorts of patients, dissemination of which in group 1 was 34,34%, and in group 2 – 29,01%. Leakage of VUA had the highest incidence rate of the total complexity of the complications: 18,18% for group 1 and 10,49% for group 2. The «small» complications (Clavien I-II) were dominated in both groups: 58,59% and 35,8%, while the «major» complications (Clavien III-IV) were fixed at 11,11% and 10,49% in groups 1 and 2, respectively. The number of patients with complications in the studied groups was comparable (p=0,534), however, their distribution varied.Conclusions. The acquisition of experience in the performing of ERP by the staff of the institute led to a statistically significant reduction of the time of catheterization of the bladder (p=0,018), the volume of intraoperative blood loss (p&lt;0,001), the frequency of conducting haemotransfusion (p=0,009), decreasing of the general prevalence of postoperative complications (p&lt;0,001), as well as the prevalence of «small» (Clavien I–II) postoperative complications (p&lt;0,001) without statistically significant difference on the similar indicator for «major» (Clavien III–V) postoperative complications (p=0,876) in the group of the conditional stage of ERP formation relative to the group of the conditional stage of ERP «implementation». The complication which was most often diagnosed in patients in both groups, had been the leakage of VUA. That required to improve of the technique of the formation of VUA during ERP.

Virtual reality head-mounted display for endoscopically-assisted implant surgery

Virtual reality (VR) is of potential use to surgeons, 1 Colt H.G. Crawford S.W. Galbraith III, O. Virtual reality bronchoscopy simulation: a revolution in procedural training. Chest. 2001; 120: 1333-1339 Abstract Full Text Full Text PDF PubMed Scopus (212) Google Scholar but means that they must interrupt the operation to watch the monitor. 2 Mascitelli J.R. Schlachter L. Chartrain A.G. et al. Navigation-linked heads-up display in intracranial surgery: early experience. Oper Neurosurg. 2017; (Available from URL: https://doi.org/10.1093/ons/opx205 (last accessed 2 August 2018)) Google Scholar A head-mounted display is the most popular wearable device to create VR images, and is already used in some specialties. 3 Matsuoka Y. Kihara K. Kawashima K. et al. Integrated image navigation system using head-mounted display in RoboSurgeon endoscopic radical prostatectomy. Wideochir Inne Tech Maloinwazyjne. 2014; 9: 613-618 PubMed Google Scholar

Long-term oncological results of radical prostatectomy in patients with localized prostate cancer

The objective: was to perform a comparative analysis of the direct results of a pathomorphological study of the organo-complex removed from radical prostatectomy and the frequency of biochemical recurrence (BCR) in patients with localized prostate cancer (RPP) in the performance of a retropubic radical prostatectomy (PRPD) and endoscopic radical prostatectomy (EDGE) clinics.Materials and methods. The clinical study involved 360 patients who had undergone PRPE or ESRD in the clinic of the Institute of Urology of the National Academy of Medical Sciences of Ukraine during 2012-2016. The patients were divided into two groups. Group 1 (n = 99) – patients who were operated in the clinic in the volume of PRPE from 2012 to 2016 inclusive, who have localized PCa, or the status of pT0. Group 2 (n=261) – patients who were operated in the clinic in the volume of ERSE from 2012 to 2016 inclusive, who have been diagnosed with localized PCa, or the status of pT0.Results. PRP and ESRP, which are performed by patients with localized PCa in a clinic for a five-year period, show comparable oncological outcomes.The conclusion. The implementation of multifocal biopsy and radical prostatectomy (RPE) in the same clinic promotes better comparability, reproducibility and greater consistency of the obtained morphological data. It is necessary to introduce a routine immunohistochemical study of biopsy material for further clinical practice to confirm the diagnosis of prostate cancer before performing RP.

3.0-T multiparametric MRI modifies the template of endoscopic, conventional radical prostatectomy in all cancer risk categories

IntroductionWe aimed to evaluate the diagnostic performance of 3.0-T multiparametric magnetic resonance imaging (mpMRI) in preoperative staging of prostate cancer (PCa) and its influence on the extent of resection during endoscopic radical prostatectomy (ERP) among cancer risk groups.Material and methodsThe data of 154 patients with PCa in whom mpMRI was performed prior to ERP between 2011 and 2015 were included. The initial decision whether to perform neurovascular bundle (NVB) sparing surgery was based on EAU guidelines. mpMRI images were reevaluated prior to prostatectomy to modify the surgical template. Imaging was compared with pathological reports to investigate the diagnostic performance of mpMRI.ResultsThe surgical template was modified in 69 (44.8%) patients after reevaluation of mpMRI. More preserving NVB sparing was attempted in 17 (11.0%) men, in whom NVB would have been resected if mpMRI had not been available. More aggressive NVB resection was performed in 52 (33.8%) men, in whom innervation would have been spared if basing solely based on guidelines. Among all PCa risk groups mpMRI had an impact on the surgical template with more aggressive surgery in 63.0% and 33.3% of men in the low- and intermediate-risk group, respectively, and more preserving in 21.4% of the high-risk patients. The change in extent of resection was not correlated with a higher risk of positive surgical margins (p = 0.196).ConclusionsPreoperative mpMRI exerts a significant impact on decision making concerning the extent of resection during ERP irrespective of the PCa risk group.

Introduction of Minimum Incision Endoscopic Radical Prostatectomy with Intentional Wide Resection for Locally Advanced Prostate Cancer at the St. Marianna University School of Medicine

Introduction of Minimum Incision Endoscopic Radical Prostatectomy with Intentional Wide Resection for Locally Advanced Prostate Cancer at the St. Marianna University School of Medicine

Analysis of the use of integral combinations of efficacy radical prostatectomy and the evaluation of a new method for the formation of vesico-urethral anastomosis in endoscopic radical prostatectomy in patients with clinically localized prostate cancer

The objective: is to conduct the search, systematization and analysis of existing literature publications on the use of various integral combinations of efficacy (ICE) of radical prostatectomy (RPE) in the treatment of patients with prostate cancer (PC), as well as to evaluate the efficiency of the new method for the formation of vesico urethral anastomosis (VUA) with performing endoscopic radical prostatectomy (EPPE) using the ICE and to compare the findings with other studies.Materials and methods. Information search was conducted using the international databases PubMed, Google Scholar and electronic databases of the National Library of Ukraine named after V.I. Vernadskiy according to July 2017. Only original research was selected, literary reviews, or works published only as theses for consideration were not included. Each literary source was analyzed in a full text version, separately determined: author’s team, year of publication of the study, the number of patients, in relation to which the ICE were calculated, the number of operating surgeons, the type of RPE, the time of observation of patients, the number of patients who reached one or another ICE of RPE and its individual components. Urine continence (UC) and erectile function (EF) after the RPE were described in the focus of the method of their fixation and evaluation, followed by analysis of the obtained data, this approach is due to the problem of the lack of standardization of these states. Some author’s comments and conclusions are given at the end of the description of the source. The works, in which several ICE were defined, were described in the part of the review of the ICE, which of them is newer.The experimental group included 24 patients who had undergone a modified ERPE in the conditions of the SI «Institute of Urology of NAMS Ukraine» for 2015–2016 years. The average follow up time for patients was 17,4±5,3 months, a monitoring point of observation was 12 months. Biochemical recurrence (BCR) was detected in the case of PSA&gt;0,2 ng/ml, positive surgical margin (PSM) was determined by the staff of the Laboratory of pathomorphology of the SI «Institute of Urology of NAMS Ukraine». UC were determined by subjective, non strict method (no pad/one safety pad). The EF was evaluated in accordance with the possibility for intercourse in patients with more than half of the cases with or without the of 5 phosphodiesterase inhibitors. Complications were classified by P.A. Clavien (2004). The evaluation of the results was carried out by determining the number of patients who achieved trifecta and pentafecta as the most commonly used ICE’s.Results. Generally, six separate ICE of RPE were identified, which were proposed by various authors from 2003 to 2012 years. The most commonly used were trifecta and pentafecta. The results obtained in the studies of other authors are summarized in tabular form. An analysis of the methods used by the authors to evaluate UC and EF are carried out. There were in the study group, a new method for the formation of VUA PSM was absent in 91,7%, the absence of BCR was established at 87,5%, the UC was noted at 91,7%, the preservation of EF was 62,5%, the complications were absent at 70,8% of patients. Thus, trifecta were reached 58,3%, and pentafecta were reached 50% of operated patients using a new method for the formation of VUA.Conclusions. At present time, various authors have developed 6 different integral combinations of the efficiency of the RPE, of which the scientific community has universally recognized and the most frequently used «trifecta» (M. Benson, 2004) and «pentafecta» (V. Patel, 2011). In this paper, there were, for the first time, integrated combinations of efficacy of endoscopic RPE in patients with localized PC, as well as detailed ways of evaluating the results of the RPE according to the criteria of objectivity and severity. The obtained performance indicators of ERPE with the proposed method for the formation of VUA correspond to the data of modern literature, the implementation of the new method does not compromise the oncological results of ERPE with the achievement of trifecta in 58,3%, and pentafecta – in 50% of patients with localized PC. The use of the «octafecta» concept regarding the surgical treatment of PC contravenes the norms of generally accepted clinical practice in Ukraine and is not recommended for implementation in clinical work.

Comparative analysis of perioperative clinical data and the dynamics of peripheral hemogram changes in patients with localized prostate cancer who have undergone retropubic and endoscopic radical prostatectomy

Comparative analysis of perioperative clinical data and the dynamics of peripheral hemogram changes in patients with localized prostate cancer who have undergone retropubic and endoscopic radical prostatectomy

EP167 - Multiparametric magnetic resonance imaging changes the extension of resection during endoscopic radical prostatectomy

EP167 - Multiparametric magnetic resonance imaging changes the extension of resection during endoscopic radical prostatectomy

Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

BackgroundLaparoscopic radical prostatectomy (LRP) is a challenging technique that is associated with a steep learning curve. We describe a novel technique to develop bladder neck traction using a Foley catheter during extraperitoneal LRP to enhance bladder neck dissection, thereby improving patient and procedural outcomes. Materials and methodsThe novel technique employed a four-trocar approach to prostatectomy, which involved the introduction of a 1-0 Vicryl suture into the extraperitoneal space using an Endo Close needle to pull up the Foley catheter tip and make the bladder neck prominent. From June 2006 to November 2012, clinicopathological data of 71 patients who underwent four-port extraperitoneal LRP (modified extraperitoneal LRP, Group 1) were assessed and compared with those from 22 patients who underwent transperitoneal LRP (Group 2) retrospectively. ResultsThe two groups were comparable in terms of pathological staging and Gleason score. The operative time was significantly shorter (p < 0.05) and the total blood loss was less in Group 1 patients (p < 0.05). No patient in either group underwent early reintervention for bleeding or blood transfusion. Bilateral or unilateral nerve sparing surgery was performed in 80.3% and 45.5% of Group 1 and Group 2 patients, respectively. The immediate, 1 month, 3 month, 6 month, and 1 year continence rates were, respectively, 19.7%, 38%, 69%, 91.5%, and 100% in Group 1 and 18.2%, 50.0%, 77.3%, 86.4%, and 95.5% in Group 2. In Group 1, 100% of patients were continent 12 months postprocedure. The potency rate was 71.4% in both groups. ConclusionImproved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

Integrated image navigation system using head-mounted display in "RoboSurgeon" endoscopic radical prostatectomy.

The safety and efficacy of minimally invasive surgery relies on visual information. We aimed to develop an integrated image navigation system (RoboSurgeon System) that combines head-mounted displays (HMDs) with multiple image modalities, and assessed its feasibility in 5 prostate cancer patients who underwent gasless single-port endoscopic radical prostatectomy. A robotically manipulated transrectal ultrasound (TRUS) system was used. In all cases, preoperative magnetic resonance (MR) images and intraoperative real-time images of an endoscope, TRUS, and HMD-mounted camera were integrated and displayed synchronously on each HMD in a four-split screen mode during the entire process. The TRUS helped identify the boundary with the adjacent structures endoscopically in reference to MR images. There were no negative incidents in intraoperative or postoperative courses. Integrated image navigation using HMDs as individualized monitors is feasible in the natural ergonomic position and may be beneficial to identify correct dissection planes. The efficacy of the RoboSurgeon System deserves further evaluation.