Category: Laparoscopic/ Robotic: Prostate

MP15-4 - Preservation of the urethra during transperitoneal Robot-Assisted simple prostatectomy: a new ejaculation sparing approach

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Recently, robotic assisted simple prostatectomy (RASP) has become a treatment option for prostatic hyperplasia (BPH) in Robotic Centres. In order to further reduce the invasiveness of this procedure, we use a “urethral-sparing approach” during the dissection of the adenoma. We present the results of our transperitoneal robotic assisted “urethral sparing” simple prostatectomy, that we named “pure” adenomectomy. 


Methods :

From August 2017, patients with indications to BPH surgery, prostate volume >100cc, and no significant median lobe at preoperative US were enrolled in the study.


Demographic and perioperative variables, early (within 30 days) functional results were recorded and analysed.  Early Complications ( 15 mL/s, and no perioperative complications) was evaluated at 1 month time point.

Surgical technique. After the prostate gland is prepared, a transversal, anterolateral incision is made halfway between the Dorsal Venous Complex (DVC) and the bladder neck. The cleavage plane between the surgical capsule and the adenoma is identified anteriorly and gently dissected at the level of prostate apex bilaterally.  Once the left lobe is mobilized a median longitudinal incision is made at the level of anterior commissure. The urethra is medialized by suction device and gently dissected from the left lobe. At the end of this step the left lobe is removed. The procedure is repeated for the right lobe. Thus the urethra is spared inside the prostatic lodge. Prostatic capsule is then barbed sutured.


Results :

Twenty-four patients were enrolled: mean age was 68 years, mean prostate volume was 176 cc, 8 patients had urethral catheter due to urinary retention. For the other 16 patients, mean IPSS score was 22 and mean Qmax was 9 ml/sec. Eight patients were sexually active before surgery.


All the patients were treated with pure adenomectomy: mean operative time was 100 minutes; blood losses were 400 mL. No intraoperative complications occurred. Bladder irrigation was stopped 24 hours after surgery in all the cases. Catheterization time and hospital stay were 4 and 6 days, respectively. Mean specimen weight was 80 grams.


No complications were recorded during follow up and the “trifecta outcome” was achieved in all patients at 30 days time point. All sexually active patients resumed their activity within 2 weeks after surgery with ejaculation maintained in all patients. 


Conclusions :

Our robot-assisted “pure” adenomectomy seems to be safe in the treatment of large prostatic adenoma; moreover it does not seem to affect sexual function and ejaculation. 

Matteo Manfredi

Urologist
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Matteo Manfredi, MD, full time Urologist at the Division of Urology, San Luigi Hospital – Orbassano (Turin) - University of Turin (Chief: Prof. F. Porpiglia).
He is a member of the Piedmont and Aosta Valley Urological Association (AUP); Italian Society of Urology (SIU); European Association of Urology (EAU).
His scientific activity is documented by more than 100 scientific publications (full papers and abstracts). The main fields of interest are: urinary stone disease, uro-oncology, laparoscopy and robot-assisted surgery, magnetic resonance imaging of prostate. He won, within a collaboration group between Division of Urology - San Luigi Gonzaga Hospital – Orbassano, Torino and Department of Molecular Biotechnology - Torino (University of Turin), of the Investigator Grant 2013 of the AIRC (Italian Cancer Research Association) with the project entitled "Dual MRI-Optical imaging agents in prostatectomy", currently underway. He participated as a co-experimenter to more than 10 clinical studies approved by the Ethic Committee of San Luigi Gonzaga Hospital – Orbassano, Torino.
Overall (as of May 2018):
the number of works in extenso (http://www.ncbi.nlm.nih.gov/pubmed) is equal to 26
the number of citations (www.scopus.com) is equal to 301
the H index (www.scopus.com) is equal to 9

Francesco Porpiglia

Full Professor of Urology
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Daniele Amparore

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Enrico Checcucci

Urology Resident
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Personal statement: Urology Resident at the University of Turin, Italy
Education and training: Currently Foundation Doctor in Italy

Title of awarded qualifications:
- 12/02/2015: Licensed to practice Medicine In Italy and registration at the Turin General Medical Council (n )
- 24/10/2014: Graduation in Medicine at the University of Turin, Italy (votation: 108/110) - Master Thesis: “TOTAL ANATOMICAL RECONSTRUCTION DURING ROBOT-ASSISTED-RADICAL- PROSTATECTOMY (RARP): EARLY FUNCTIONAL OUTCOMES OF A NEW TECHNIQUE"; Printout dignity. Supervisor: Prof. Francesco Porpiglia
- 07/2008: High School Diploma (votation: 86/100)

Name and type of organization providing education and training:
- 2003-2008 Liceo Salesiano Valsalice, Turin- Italy
- 2008-2015 University of Turin, Italy
- 2013-2015 Internee at “San Luigi Gonzaga” Hospital, division of Urology, Orbassno-Turin, Italy. Director: Prof. F. Porpiglia
- 03/2014 – 06/2014 Elective student at Kings College of London; internship at Guy’s Hospital, division of Urology, under supervision of Professor P. Dasgupta

Diletta Garrou

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Giorgio Alleva

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Razvan Gabriel Niculescu

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Roberta Aimar

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Sabrina De Cillis

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Federico Piramide

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Marco Cossu

Department of Urology, AOU San Luigi Gonzaga Orbassano - Turin; University of Turin
Orbassano, Piemonte, Italy

Francesca Ragni

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Massimiliano Poggio

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
orbassano, Piemonte, Italy

Ivano Morra

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Turin, Piemonte, Italy

Cristian Fiori

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy