Category: Robotic Surgery: Lower Tract - Malignant
Introduction & Objective :
Radical prostatectomy can be performed with different surgical techniques. However, robotic surgery is the most confined technique today with high continence rates and early postoperative recovery time. Applying robotic surgery to patients who previously underwent open prostate surgery requires considerable experience. In this case we present our experience of robot assisted laparoscopic radical prostatectomy (RALP) patient who underwent open retropubic prostatectomy six years before.
A-72-years old male patient applied our clinic with high level of prostate specific antigen (PSA) (4.26 ng/mL). His digital rectal examination was unremarkable. Transrectal ultrasound guided prostate biopsy was performed and pathological result was Gleason 3 + 3 prostate adenocarcinoma in four cores of right and four cores left lobes of prostate. Metastatic evaluation with bone scintigraphy and abdominal magnetic resonance imaging (MRI) was unremarkable.
In this video we defined the technical details during RALP in a patient who underwent open prostatectomy. Identification of bladder neck and exposing preprostatic urethra needs much more experience in such kind of patients. Anatomical changes may disrupt the orientation of the surgeon. However, these difficulties can be overcome by applying bladder neck preservation technique and prostate apex preservation technique previously described by our team.
Patients who have previously undergone open prostatectomy may have longer operative times. The length of this process will depend entirely on the surgeon's experience and technique. We do not have significant changes in our surgery times because our center has experience of more than 250 robotic radical prostatectomy procedures yearly and we have been using bladder neck preservation technique and prostate apex preservation technique.
Surgical experience and knowledge of anatomy are very important when robotic surgery is required in patients with anatomical changes due to various operations. Providing continence in patients as well as performing the correct oncological surgery is also the most important point determining comfort after radical prostatectomies.
Sercan Yilmaz– Nigde, Nigde, Turkey
Halil Cagri Aybal– Urologist, Ankara, Ankara, Turkey
Serdar Yalcin– Urologist, Ankara, Ankara, Turkey
Engin Kaya– Urologist, Ankara, Ankara, Turkey
Eymen Gazel– Urologist, acibadem, Ankara, Ankara, Turkey
Lutfi Tunc– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey
Ankara, Ankara, Turkey
Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey