BERKELEY, CA (UroToday.com) - Surgical treatment of benign prostatic hyperplasia (BPH) is reserved for men who do not respond to or have a contraindication to medical management, or those presenting with complications of urinary retention.
Transurethral resection of the prostate (TURP) is limited by gland size and therefore open simple prostatectomy (OSP) is preferred in those patients. The first robotic simple prostatectomy (RSP) was described by Sotelo et al in 2008. The robotic platform allows for transfer of OSP skills, more so than a pure laparoscopic approach, and we published our series of 9 patients who underwent RSP in a community setting.
We performed all of our cases via a standard transperitoneal approach, with port placement similar to that of a robot-assisted radical prostatectomy. We began resection of the adenoma with a transverse incision 1-2.5 cm from the prostate-bladder junction using electrocautery. We found that we could safely omit the traditional rows of hemostatic sutures controlling Santorini’s plexus, instead effectively using bipolar electrocautery. Another modification was a traction suture placed in the adenoma, allowing for upward mobilization and dissection of the posterior plane. Using the 30-degree down camera provided excellent visualization of the empty prostate capsule, thereby allowing for the primary closure of any capsulotomies. Interrupted sutures secured the bladder neck to the posterior capsule, a 3-way catheter was placed under direct vision, and the anterior capsulotomy was closed using a running absorbable suture. No patient received a suprapubic tube, but all received close suction drains. All patients were managed with continuous bladder irrigation, similar to TURP patients, and the average length of hospital stay was 32 hours. No transfusions were required and no major complications occurred.
Since publication of our series, we have performed three additional RSPs with consistently good outcomes. We have also found that in those patients with very large (>150gr) glands, a suprapubic approach utilizing a “T-bone” incision along the anterior commissure can help facilitate adenoma removal at the apex without undue traction on the distal urethra and sphincter, and the subsequent closure is not technically difficult. In our series and others, RSPs were associated with a short average hospital stay (32 hours) and a low blood loss (average 206 cc).
- Sotelo, R., et al., Robotic simple prostatectomy. Journal of Urology, 2008. 179(2): p. 513-5.
- Sutherland, D.E., D.S. Perez, and D.C. Weeks, Robot-assisted simple prostatectomy for severe benign prostatic hyperplasia. Journal of Endourology, 2011. 25(4): p. 641-4.
Douglas Sutherland, Timothy J. Tausch, and David Weeks as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.