Category: Robotic Surgery: New Techniques - Benign
Introduction & Objective :
Surgical management of benign prostatic hypertrophy (BPH) is often reserved for patients with severe lower urinary tract symptoms recalcitrant to medical therapy. The current mainstay for advanced BPH not amenable to endoscopic techniques includes simple prostatectomy and may be performed via a variety of techniques. We introduce a novel technique for the combatant of advanced BPH, which involves removal of the totality of prostate tissue.
9 patients who underwent negative prior work-up for abnormal PSA were referred to our center and underwent RALTP. Indications for surgery included the typical indications for simple prostatectomy (SP) but also included age > 70, patient preference and to prevent the recurrence of BPH. Unlike SP in which enucleation of the adenoma is performed not inclusive of the peripheral zone, RALTP employs complete removal of the prostate to the level of the pseudocapsule, sparing the seminal vesicles and vas deferens, thereby preserving peri-prostatic tissue and the neurovascular bundle. The RALTP allows for maximal urethral length, intact sphincter mechanism, and circumferential sparing of the bladder neck to permit a complete anatomical vesico-urethral anastomosis. In this video, we demonstrate the steps of RALTP.
9 patients underwent RALTP with a mean age of 70.67 and BMI of 28.9. Preoperative IPSS score was greater than 22, excluding four patients catheter-dependent in urinary retention. Preoperative/postoperative mean PSA was 7.8/.10. Mean resection weight was 104.5 grams. Mean postoperative post-void residual was 28.3 ml with excellent flow rates (Qmax >22). None of the patients required CBI and length of stay for all patients was between 1-2 days.
RALTP is a minimally invasive procedure that removes all prostatic tissue, preserving continence, minimizing impotence, preventing recurrence of BPH, and taking care of incidental cancer prostate without recurrence.
Wake Forest Baptist Medical Center
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina
Dr. Hemal is working as a professor in the department of Urology, Comprehensive Cancer Center & Prof., Institute for Regenerative Medicine at Wake Forest Baptist Medical Center. He is well known for his pioneering work in minimally invasive surgery. He has been active in the field of endourology since 1989, laparoscopy since 1992 and robot-assisted surgery since 2001. His contributions to laparoscopic & robot-assisted urologic surgery include the development of new techniques in uro-oncology & commitment to sharing and disseminating knowledge. He has conducted live demonstrations of endourological, laparoscopic & robot-assisted urologic procedures at more than 350 conferences around the world. He has been a visiting professor to more than 350 institutions around the globe to deliver guest lectures and keynote speeches. His trainees have been involved in the establishment of more than 50 minimally invasive programs. He has edited six books & 450 scientific papers and chapters in the book. He is on editorial board of several journals and President of society of robotic urologic surgery.He serves as a member of scientific committee in American Urology Association, World Congress of Endourology & SIU. Dr. Hemal has been the recipient of many academic distinctions and awards. He has been awarded three times by President of India including the most prestigious honor a physician can receive, the “Dr. B.C. Roy Award,” in 2004 for his contributions in the field of cost-effective minimally invasive surgery and highest civilian honor “Padma-Shree” in 2007 for development of robotic urologic surgery. Other prestigious awards to his credit are Urologist of the Decade award, Guest Scholar of the American College of Surgeons, SIU scholar and Fulbright scholar. Dr. Hemal is consistently included in Best Doctors of America, Top Doctors of America, Top Prostate Cancer Specialists and Who’s Who in the World for past several years.