Category: Robotic Surgery: Lower Tract - Malignant
Introduction & Objective : One of the main complications of radical prostatectomy (RP) is stress urinary incontinence. The introduction of robot-assisted surgery, as well as the fundamental research of the role of the supporting apparatus (ligaments and fascia) and the muscular component of the pelvis, allow performing operations whose competent technical performance today virtually guarantees patients immediate continence after catheter removal.
The analysis of robot-assisted fascia- and nerve-sparing RP was performed in 37 patients with low oncological risk. Speaking about the survey features, 25 (67%) patients underwent MRI of the pelvis before surgery to exclude the spread of tumor to the basis of the prostate and evaluate the topography of apex. The age of patients - from 45 to 76. The maximum prostate volume is 106 cm3. The operations were performed on the Da Vinci SI. The duration of operations was from 100 to 180 (mean -135). The hemorrhage, which required blood transfusion, was not observed. The duration of the bladder drainage in 30 patients was from 7 to 10 days; in 5 cases, from 15 to 35 days. The inconsistency of the anastomosis was due to hematoma in the bed of the prostate. Other complications, with the exception of the port hernia (n-1), were not noted.
Results : This technique allowed the immediate continence to be preserved in 29 (73%) patients. In 3 cases, the PAD-free status recovered within a week after catheter removal. Patients with longer bladder drainage reached the full continence within the first month after catheter removal. Such a result, in our opinion, along with the generally recognized aspects, is achieved due to the complete preservation of the fascial-ligament apparatus of the low urinary tract, and also by the absence of mechanical and thermal damage to branches of the genital nerve that pass in the surface layers of the levator (the main source of somatic neuroregulation of the urethral sphincter). Analysis of recovery of erectile function is not completed.
This fascia and neurovascular preservation technique allows for
decreasing risks of positive surgical margins,
earlier recovery of continence immediately after catheter removal,
and high chances of the recovery of spontaneous or the drug-induced erectile function.
Mikhail Enikeev– Head of Department, Sechenov University, Moscow, Moskva, Russia
Peter Glybochko– Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Dmitry Korolev– Sechenov University, Moscow, Moskva, Russia
Andrey Vorobyev– Sechenov University, Moscow, Moskva, Russia
Igor Fokin– Sechenov University, Moscow, Moskva, Russia
Margarita Gaas– Sechenov University, Moscow, Moskva, Russia
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia