24th World Congress of Endourology 2006 - Session MP18 Robotics: Prostate 1

World Congress of Endourology, Cleveland, OH.

This session consisted of 30 posters of high quality work relating to robot assisted radical prostatectomy.
The most interesting abstracts included work presented by Dr. Capello from Rochester that demonstrated that extraperitoneal robot assisted radical prostatectomy could be efficaciously performed for older patients although return to continence may be delayed when compare to younger patients.

Dr. Ahlering from UCI presented two very interesting posters. The first dealt with a technique change from bipolar energy based nerve sparing to a cautery free technique. The new technique involves the placement of laparoscopic bulldog clips on the pedicle with cold dissection of the neurovascular bundle away from the prostate. The technical change resulted in a marked increase in the number of patients that regained early potency. At 3 months, the cautery free group had 42% recovery vs. 8.3% for the cautery technique. At 9 months, the cautery free group had 76% recovery vs. 20%.

In another poster, Dr. Ahlering found that a slightly wider resection of the urethra of 3-6 mm resulted in better margin rates without decreasing continence. Overall margin rates were 17.6% versus 6% before and after the technique change. This decrease was seen in both T2 and T3 pathological specimens. Continence rates were stable with 1 year rates of 89% and 95% before and after respectively.

Dr. Patel from Ohio State presented data regarding early PSA recurrence in a large number of patients after robot assisted radical prostatectomy. The positive margin rate overall was 10.7% and PSA recurrence was seen in 4.2% of patients in 354 patients with a mean followup of 23 months. They have not yet seen a patient with T2 pathological disease have recurrent disease. Gleason score of 7 or greater also is a significant risk factor of recurrence in this series.

Dr. Abraham from the University of Pennsylvania presented a retrospective comparative trial of bladder neck sparing after robotic prostatectomy. They found there was no difference in early or late continence but did find that the anastomosis could be performed much easier subjectively. Oncologically, the procedure was also seemed very safe with only one positive margin around the bladder neck in the early learning curve of the procedure.

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