Extraperitoneal robot-assisted laparoscopic radical prostatectomy: initial experience

To report our initial experience and technique of performing robot-assisted laparoscopic radical prostatectomy [RALP] with the extraperitoneal approach. Twenty-seven patients, between September 2010 to January 2012, were included in the study. All patients underwent extraperitoneal robot-assisted radical prostatectomy. Patients were placed supine with only 10-15 Trendelenburg tilt. The extraperitoneal space was developed behind the posterior rectus sheath. A five-port technique was used. After incision of endopelvic fascia and ligation of the deep venous complex, the rest of the procedure proceeded along the lines of the transperitoneal approach. The mean patient age, prostate size and Gleason score were 67 +/- 1.8 years, 45 +/- 9.55 g and 6, respectively. The mean prostate-specific antigen [PSA] was 6.50 ng/mL. The mean time required for creating extraperitoneal space, docking of robot and console time were 22, 7 and 94 min, respectively. The mean time to resume full oral feeds was 22 +/- 3.45 h. There were no conversions from extraperitoneal to transperitoneal or open surgery in our series. Pathological stage was pT1, pT2a and pT3b in 11 [40.74%], 14 [51.85%] and two [7.4%] patients, respectively. Two patients had positive surgical margins and two had biochemical recurrence at the last follow-up. Our mean follow-up was 12 +/- 3.30 [2-17] months. The overall continence rate was 83.33% and 92.4% at 6 and 12 months, respectively. Extraperitoneal RALP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate

Robot-assisted laparoscopic augmentation ileocystoplasty in a tubercular bladder

Some of the patients with genitourinary tuberculosis [GUTB] present to the urologist with small contracted bladders or with significant renal damage. [1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine