Category: Robotic Surgery: Lower Tract - Benign

VS10-5 - Indocyanine green guided urethra-sparing robot assisted Millin’s prostatectomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Millin's prostatectomy is an established surgical option for large benign prostatic hyperplasia (BPH). Endoscopic surgical options provided significant benefits in terms of early urethral catheter removal and faster return to daily activities. The main pitfalls of surgical options remain the retrograde ejaculation, to date considered an intrinsic side effect of surgery.


Methods :

In this video we first report surgical steps of a robot assisted Millinâ€TMs prostatectomy with complete preservation of prostatic urethra in order to preserve antegrade ejaculation. The first step was a retrograde injection of 10 mL of indocyanine green through the urethral catheter placed at navicular fossa. Once prepared the Retzius space the bladder neck was meticulously isolated in order to expose the proximal prostatic urethra. BPH dissection started from the right lobe, developing the dissection plane starting from the base and progressively moving to 12 o'clock site. Sharp and blunt dissection were progressively used to enucleate the lobe. Near infrared fluorescence (NIRF) imaging was used when dissection moved towards the median aspect of the lobe in order to improve visualization of the bladder neck and of the urethra, to avoid any unintended violation of urinary tract. Energy free dissection was used in proximity to urinary tract. Residual periurethral tissue was resected under NIRF imaging. A minimal bladder neck incision was performed to ensure complete resection of the median lobe. Urinary tract was sutured with 3 0 monocryl suture. Once completed the resection, a Foley catheter was introduced and the cuff inflated in the prostatic urethra with 10 mL of saline solution. Finally, the bladder was approximated to the prostatic fossa with two running monocryl sutures.


Results :

Operative time was 115 minutes. Estimated blood loss was 100 mL. Continuous bladder irrigation was not necessary. Urethral catheter was removed on third postoperative day. Patients was discharged on 4th postoperative day.
On final pathology, 75 grams of benign hyperplastic tissue were confirmed.
At 1 month evaluation, IPSS score decreased from 22 to 8, and patient reported a satisfying antegrade ejaculation.


Conclusions :

We first described a NIRF imaging guided technique to perform robot assisted urethra sparing Millin's prostatectomy with preservation of ejaculatory function.

Giuseppe Simone

Consultant
“Regina Elena” National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Leonardo Misuraca

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Gabriele Tuderti

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Mariaconsiglia Ferriero

MD, PhD
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Francesco Minisola

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Salvatore Guaglianone

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Michele Gallucci

Roma, Lazio, Italy