Category: Laparoscopy: Lower Tract - Malignant
VS11-2 - Tips and tricks to improve continence outcomes in 3-D laparoscopic radical prostatectomy:A 3600 approach
Introduction & Objective : Urinary continence after radical prostatectomy forms an integral determinant of functional outcomes and thus quality of life. In this video, we will demonstrate various tips and tricks to improve continence outcomes during 3-D laparoscopic radical prostatectomy (LRP),using a 360 degree approach .
Methods :
All consecutive patients who underwent 3-D LRP for localized prostate cancer by a single surgeon between January 2012 and March 2017 at our institution were included .The various clinical data were recorded and analyzed.We have used these maneuvers in all our patients - nerve sparing procedure whenever feasible/ preservation of maximal intrapelvic urethral length /modified bladder neck reconstruction / Rocco stitch/modified Van-Velthoven water tight ,tension free vesicourethral anastomosis /Switching 30 degree down scope to 30 degree up scope and vice-versa during vesico-urethral anastomosis /anterior musculofascial reconstruction .This video presentation demonstrates our surgical technique .
Results : A total of 91 patients were included in the study. The mean BMI was 25.5 Kg/m2. The clinical stage ≤ T2 c and ≥ T3 a were seen in 88.8% and 11.2%respectively. The mean operating time and mean estimated blood loss were 193.9 min and 190.5 ml respectively. There was no conversion to open. The right unilateral, left unilateral and bilateral nerve sparing was done in 35.1%,23% and 9.8% patients respectively. The mean intrapelvic urethral length was 19.1 mm. The mean hospital stay and mean catheterization time were 4.31 days and 10.8 days respectively. The intraoperative and postoperative complications were seen in 9(9.8%) and 11(12.1%) respectively. The positive surgical margins were found in 5.4%(5) patients. At mean follow up of 15.1 months, the continence rate at 3 months and 12 months were 75.8% and 94.5% respectively. The potency rate at 12 months was 59.3% with biochemical recurrence of 9.8%.
Conclusions :
Surgeon’s experience and volume are key determinants in functional outcomes of LRP. Nerve sparing should be performed wherever oncolgically safe. The maximum intrapelvic urethral length should be maintained without compromising cancer control. The bladder neck reconstruction/Wide, water tight, tension free vesico-urethral anastomosis/ Anterior musculofascial reconstruction maneuvers can also help in improving continence outcomes.
Anup Kumar
– Professor and Head, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India- NK
Niraj Kumar
– Assistant Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - PV
Pawan Vasudeva
– Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - SY
Siddharth Yadav
– Assistant Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - SK
Sandeep Kumar
– Assistant Professor, Department of Urology and Renal Transplant ,VMMC and Safdarjang Hospital,New Delhi,India, Delhi, Delhi, India - PG
Pankaj Gupta
– Senior resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - SK
Saurav Kumar
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - VP
Vishnu Prasad
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - YP
Y m Prashant
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - VT
Vijay Tyagi
– senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India