Category: Laparoscopy: Lower Tract - Malignant
Introduction & Objective :
In this video,we aimed to present our experience with laparoscopic radical prostatectomy(LRP) in a kidney allograft recipient.
59-year-old patient,status post living related kidney transplantation in 1988,PSA level of 8ng/mL was determined while being evaluated for lower urinary tract symptoms.DRE revealed slightly enlarged prostate with benign findings.PIRADS 4 lesion was detected on the right apical posterolateral part of peripheral zone on multiparametric prostate MR.Cognitive transrectal fusion biopsy targeting the lesion revealed prostatic adenocarcinoma,Gleason score 6(3+3) in two foci.After showing no metastasis on bone scintigraphy,patient was scheduled for LRP.In the supine position pneumoperitoneum was achieved by Veress needle from Palmer’s point.Classic inverted V port configuration was not achieved due to left sided allograft kidney,instead 12mm optical port 3cm right lateral and above the umbilicus was placed.Under direct vision two 10mm and two 5mm working ports were also placed transperitoneally.Retzius space was entered by the aid of Thunderbeat device.Muscles forming external urethral sphincter were removed from the lateral and posterior apical border by blunt dissection.Then dissection was started from bladder neck by Thunderbeat device according to descending technique.After releasing bladder neck,both vas deferens and seminal vesicles were freed and vascular structures were controlled by hem-o-lok clips.Following opening of the Denonvilliers fascia,pararectal fatty tissue was reached and posterior dissection of prostate was started.After bringing posterior dissection to adequate level on the apex,dorsal vein complex was controlled with 2/0 V-Loc suture from anterior aspect of prostate.After dissecting urethra,apical dissection on both sides was completed.Then urethrovesical anastomosis was performed according to Van Velthoven technique by using 3/0 17mm monofilament absorbable sutures.After inflating urethral catheter’s balloon with 15cc of NS,the integrity of the anastomosis was controlled by instilling 150cc of NS into the bladder.
Results : Insufflation duration was 110 minutes and estimated blood loss was 300cc.Patient was discharged following removal of the drain on postoperative 3rd day.Urethral catheter was removed after obtaining cystogram with no extravasation on postoperative 7th day.Pathological examination revealed prostatic adenocarcinoma,Gleason score 6(3+3),pT2a with negative surgical margins.
In the treatment of localized prostate cancer even in the kidney allograft recipient,LRP can safely be utilized parallel to increasing experience.
Ender Ozden– Professor in Urology, Ondokuz Mayis University, School of Medicine, Department of Urology, Atakum, Samsun, Turkey
Murat Gulsen– Atakum, Samsun, Turkey
Suleyman Oner– atakum, Samsun, Turkey
Firat Akdeniz– Trabzon, Trabzon, Turkey
Yarkın Kamil Yakupoglu– Atakum, Samsun, Turkey
Yakup Bostanci– Atakum, Samsun, Turkey
Ali faik Yilmaz– Atakum, Samsun, Turkey
Professor in Urology
Ondokuz Mayis University, School of Medicine, Department of Urology
Atakum, Samsun, Turkey