Laparascopic robot assisted transvesical prostatectomy for large benign hyperplasia
John H.A.1, Engel N.*1, Fischer B.*1, Fehr J.-L.1
1Klinik Hirslanden, Zentrum für Urologie, Zürich, Switzerland
Introduction and objectives: Open surgery in benign hyperplasia is recommended for severely enlarged glands. However, the procedure is invasive, and the adenomectomy is performed by blunt dissection from the capsule, especially in the apical and sphincteric area. Important intraoperative bleeding may occur. We evaluated the faisability of a laparoscopic robot assisted transvesical prostatectomy.
Methods: Extraperitoneal laparoscopic approach is performed by balloon-dilation and 5 trocars are positioned (12mm camera-port, 2x8mm robotic ports, 5mm and 12mm assistant ports). After the bladder is filled with 200ml saline, vertical cystotomy is performed. Two preliminary holding sutures expose the ureteral crest, the ureteral orifices and median lobe. A hot scissor incision creates the dissection plane at the dorsal bladder neck. Median lobe and both lateral lobes are gently freed from the capsula as a whole or one lobe at a time. Apical dissection is performed under visual control to prefent sphincteric injury. After total removal of the adenoma, hemostasis is achieved under visual control within the prostate fossa. An irrigation urethral catheter Ch20 is introduced and blocked in the prostatic fossa. Finally, bladder incision is closed by a running vicryl 2-0 suture. A suction drain is placed and the specimen is removed by an endo-bag through the subumbilical incision.
Results: The movie demonstrates, that robot assisted transvesical prostatectomy is faisable with an excellent insight into the prostatic fossa. Bleeding vessels are vulgurated under visual control. The sphincteric area remains efficiently protected. Postoperative pain is minimal due to only small incisions, the indwelling catheter is removed after 4-5 days.
Conclusions: Robotic extraperitoneal transvesical prostatectomy for severely enlarged glands is faisable and offers distinct benefits compared to open surgery regarding intraoperative visual control of the prostatic fossa, postoperative pain and recovery time. To our knowledge, this is the first report, that describes a robot assisted laparoscopic technique to treat large benign prostatic adenomas.