Gasless robotic perineal radical prostatectomy: experience of the first 12 cases / Prostatectomía radical perineal robótica sin gas: experiencia en los primeros 12 casos

OBJECTIVE: To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP). METHODS: We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed for all patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed. RESULTS: The mean age of the patients was 62.6 ± 6 years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively. CONCLUSIONS: Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series

OBJETIVO: Presentar nuestros resultados en los primeros 12 pacientes en los que hemos realizado prostatectomía radical perineal robótica sin gas. MÉTODOS: Se realizó la prostatectomia radical robótica perineal sin gas en 12 casos entre agosto 2018 y octubre 2018. RNM multiparamétrica se realizó en todos los pacientes para excluir enfermedad avanzada local. Las características demográficas, detalles técnicos y datos intra e postoperatorios fueron analizados. RESULTADOS: La mediana de edad de los pacientes fue de 62,6 ± 6 años. El IMC medio fue de 27 ± 4 kg/m2, cuatro pacientes tenían historia de cirugía abdominal previa. EL PSA preoperatorio fue de 7,4 ± 2,5 ng/mL. El tamaño prostático medio fue de 40 ± 10,2 cc. El tiempo medio de disección perineal fue de 45,6 ± 5,8 minutos. El tiempo medio de consola y el tiempo quirúrgico total fueron de 117,8 ± 28,1 y 163,3 ± 30,7 minutos, respectivamente. El tiempo medio a la retirada de sonda fue de 9,2 ± 1,9 días. La continencia inmediata fue de 25% después de la retirada de la sonda y la tasa de continencia fue de 75% y 92% al 3r y 6º mes de seguimiento, respectivamente. CONCLUSIONES: La prostatectomía radical robótica perineal sin gas es un procedimiento eficiente y seguro en la cirugía del cáncer de próstata. Aunque estudios prospectivos randomizados y estudios comparativos son necesarios con más series de pacientes

Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery.

BACKGROUND AND OBJECTIVES: Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP). METHODS: Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed. RESULTS: Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D'Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2.8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11.1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates. CONCLUSIONS: RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate.