Category: Robotic Surgery: Lower Tract - Malignant
Introduction & Objective : Radical prostatectomy is one of the standard management options for localized prostate cancer. The better understanding and visualization of the peri-prostatic surgical anatomy provided the basis for improved functional recovery after radical prostatectomy. Technological and technical advancements are helping to improve the trifecta outcomes.
Methods : Between August 2002 and February 2017, ten thousand robotic-assisted laparoscopic radical prostatectomies were performed by a single surgeon. Demographic, oncological parameters, perioperative and functional outcomes were prospectively collected in the institutional review board approved prostate cancer database. Complications, positive surgical margin data, and trifecta outcomes were constantly monitored, reviewed and technical modifications were made accordingly. These technical advancements were published in peer-reviewed urological journals. Many of these important techniques are still being used in our center with superior outcomes. In this video, we discuss the technical modifications adapted to improve the robotic-assisted laparoscopic radical prostatectomy outcomes in our center.
Results : Overall 96.9% of patients achieved full continence. Men with good pre-operative erectile function (SHIM score ≥ 22) and full nerve spare had potency recovery in 86.4%; of them, men younger than 55 years had best erectile function recovery (91.8%). Initial technical innovations like suspension stitch, bladder neck, and posterior reconstruction were to improve the urinary continence. Suspension stitch was used in approximately 9,500 cases and posterior reconstruction in last 9,000 cases. Further modifications were aimed to improve potency outcomes. Athermal seminal vesicle dissection and retrograde nerve-sparing techniques were used in 8,000 cases. The description of landmark arteries helped in graded nerve-sparing of 5,000 cases. Use of 180 degrees toggling of the camera which provides better visualization during retrograde nerve sparing is being used regularly over last 2,000 cases.
Conclusions : Constant monitoring and review of outcome data at regular intervals help the ongoing learning process. Appropriate technical modifications for robotic-assisted laparoscopic radical prostatectomy result in improved clinical outcomes.
Hariharan Palayapalayam Ganapathi– Director of Clinical Outcomes, Florida Hospital, Celebration, Florida
Fikret Onol– Florida Hospital Global Robotics Institute, Celebration, Florida
Travis Rogers– Florida Hospital Global Robotics Institute, Celebration, Florida
Bernardo Rocco– Modena, Emilia-Romagna, Italy
Vipul Patel– Florida Hospital Global Robotics Institute, Celebration, Florida
Director of Clinical Outcomes