PERCUTANEOUS TRANSVESICAL SINGLE-PORT ROBOTIC SIMPLE PROSTATECTOMY: STEP-BY-STEP AND INITIAL EXPERIENCE
Aim: To present an instructional video in a step-by-step format demonstrating the percutaneous transvesical single-port robotic simple prostatectomy (pSP-RSP) using the novel da Vinci SP® platform and our initial experience with the method.
Methods: Patient is positioned in the supine position. The bladder dome is identified by a needle puncture, the skin is marked and a 3 cm infra-umbilical incision is performed. Dissection is carried out until clear visualization of the bladder dome. Stay stitches are applied in each side demarking the incision area, and the cystostomy is performed. The Alexis Retractor is inserted directly in the bladder, the 25-mm single-port cannula and a 12-mm laparoscopic accessory port are inserted through the GelSeal Cap, the GelSeap Cap is plugged to the Alexis Wound Retractor, the bladder is inflated with 12 mmHg CO2 and the robot is docked. The adenoma is accessed and enucleated. Finally, a mucosal advancement flap is sutured to the urethra in a 360 ° fashion.
Results: From February 2019 to March 2019, 4 consecutively cases were performed using this technique. Mean operative was 182.2 minutes, mean estimated blood loss was 350 ml and the mean length of stay 37 hours and 26 minutes. 2 out of 4 cases went out of the operation room with a 2-way foley catheter and no bladder irrigation and were discharged in the next day. No drain was inserted and no surgeries were converted to open approach.
Conclusion: Our initial experience demonstrates adequate feasibility and our initial results showed minimal bleeding, no need for drains or extra-portals, minimal usage of postoperative opioids, shortening the postoperative hospital length of stay and opening the possibility of no bladder irrigation and the possibility of outpatient management in selected cases.
single-port; da vinci sp; bph; robotic surgery; simple prostatectomy
Hiperplasia Prostática Benigna
Cleveland Clinic Foundation - - United States
Guilherme Vinicius Sawczyn, Rair Valero, Jihad Kaouk