Category: Robotic Surgery: Lower Tract - Benign
Introduction & Objective :
For patients with symptomatic large volume benign prostate hyperplasia, open simple prostatectomy has traditionally been the treatment of choice. Laparoscopic approach has become an effective surgical option as well. Since the first case of laparoscopic approach in 2002, surgeons have continued to expand the use of minimally invasive surgery. In 2008, the first case of robotic simple prostatectomy (RSP) was reported. We herein report our surgical technique for conducting Freyer’s Transvesical simple prostatectomy and initial experience.
71 male with LUTS refractory to medical treatment and having 180gms of prostate on ultrasound with high PVR opted for robotic assisted freyers prostatectomy. With the patient placed in trendelenberg position the steps of the surgery after docking included: anterior cystotomy and prostate exposure, circumferential bladder neck incision, disconnecting the urethra and adenoma, approximation of the bladder neck and urethral mucosa and closure of the bladder.
The International Prostate Symptom Score at baseline was 24 which improved to 7 at the end of 3months. The console time was 140 minutes. The median estimated blood loss was 100 mL. The resected prostate weight was 157gms. The hospital stay was 5 days and the catheter was removed after 10 days. The patient gained significant improvement in maximum urine flow rate (preoperative vs. postoperative 8.8 mL/min vs. 17 mL/min, p < 0.001) and postvoid residual urine (preoperative vs. postoperative 125 mL vs. 10 mL, p < 0.001).
Robotic simple prostatectomy is a safe & feasible alternative for large prostates. The dexterity offered by the robot is very useful. Comparative studies are needed to establish its benefits and cost-effectiveness as compared to open and endourological approaches.
Yuvaraja Tb– Head of robotic surgery and urooncology, kokilaben dhirubhai ambani hospital, mumbai, Maharashtra, India
Santosh Waigankar– Post Doctoral Fellow in Urooncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
Srivathsan Ramani– Fellow - Robotic Urooncology, kokilaben dhirubhai ambani hospital, mumbai, Maharashtra, India
Head of robotic surgery and urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India
Post Doctoral Fellow in Urooncology and Robotic Surgery
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India
Dr. Santosh Waigankar is a trained urologist from India who is presently pursuing urooncology and robotic surgery. After completing his training in urology, he decided to venture into subspecialty of urooncology and robotic surgery. He was selected as the first Vattikuti fellow in robotic urooncology in India (2015) and joined Kokilaben Dhirubhai Ambani hospital under the mentorship of Dr. T. B. Yuvaraja. He has been since associated with the department gaining valuable experience in Si and Xi DaVinci setups, as a beside and a console surgeon.
Fueled with curiosity and eagerness to learn he loves to interact with like-minded people across India and all over the world. He believes that gaining professional experience globally helps oneself to improve one’s perspective and broaden one’s approach to managing urological cancers.
He loves research and wants to work in areas as well looking into “unconventional” issues related to urological cancers as a whole e.g. molecular biology and ways to augment treatment outcomes in future. Doing research is his way of reciprocating back to the community.
His first international entry at the European Robotic Urology Society (ERUS 2017) won him the second prize for the best poster submission. The paper analyzed the “measured” outcomes post robotic partial nephrectomies. He has been awarded the scholarship for attending the 38th Société Internationale d'Urologie Congress (SIU 2018), scheduled to be held in Seoul.
He has keen interest in single port robotic surgery and aspires to get trained in the same.
He loves making friends from all walks of life and believes in knowledge sharing to enrich oneself. He is active on social media. He loves blogging and photography and follows cricket, tennis and F1 racing. Balancing between family, friends and professional life has been his priority always.