AUA 2017: Robotic Perineal Prostatectomy (Kaouk)

Boston, MA ( Dr. Jihad Kaouk concluded the standing room only first Plenary session of the AUA 2017 Annual meeting, Surgical Techniques: Radical Prostatectomy, by demonstrating how far the minimally invasive aspect of radical prostatectomy has come by showing a video of his initial experience with robotic perineal prostatectomy.

Dr. Kaouk started by noting that the development of instruments to allowing single site intracorporeal triangulation of instruments has advanced the field to allow cases such as robotic perineal prostatectomy to be performed. This technology minimizes clashing of instruments outside the body, facilitating docking of the robot and working via the perineal space. Furthermore, this approach may be more feasible and safer for patients that have had prior abdominal surgery or have a high body mass index.

Dr. Kaouk commences this procedure by making a 2-3 cm incision in the perineum and then expanding the perineal space, prior to placement of a working gel port. The robotic ports are then placed through the gel port and robot is docked. Once at the level of the prostate, after dissection of the seminal vesicles and vas deferens, the bilateral prostatic pedicles are carefully dissected and divided. Following this, the membranous urethra is dissected and divided, as is the bladder neck in a similar fashion. The urethrovesical anastomosis is then performed in the usual robotic assisted fashion with a running 3-O v-loc suture.

Dr. Kaouk concluded his presentation by showing an additional video demonstrating his early experience with single site robotic perineal prostatectomy with pelvic lymphadenectomy in cadaver models using the next generation da Vinci SP platform. As Dr. Kaouk concludes, the next generation is looking to “minimize minimally invasive approaches to radical prostatectomy.”

Presenter: Jihad H. Kaouk, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH, USA

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA