Mediathek

Robotic assisted radical prostatectomy of a very large (700ml) Adenocarcinoma of the prostate

Schlagworte: Diagnostik
04.11.2021Deutsch

Abstract

Robotic assisted radical prostatectomy of a very large (700ml) Adenocarcinoma of the prostate

J.-U. Stolzenburg1, V.K.A. Arthanareeswaran1, O. Espig1
1Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: In this video we present our experience in managing a patient with unusually large prostate measuring of 700ml diagnosed with prostate carcinoma.
Materials and methods: A 75-year-old patient presented with PSA 670ng/dl. Ultrasound revealed a large prostate measuring 700ml. Prostate biopsy revealed Adenocarcinoma of prostate with Gleason Score 4+4=8. Staging CT and PET scan showed no metastasis. Rectoscopy was performed to rule out rectum infiltration. The patient was started on anti-hormone therapy for one month. We demonstrate our robot assisted surgical technique of radical prostatectomy with peritoneal flap fixation.
Results: The patient was placed in supine position in a 25 degree trendelenburg position. A typical 6 trocar setup was used. The Retzius space was dissected and pelvic lymphadenectomy was performed on both sides. The ureters were looped on both sides. Inspite the abnormal size of the prostate, the plane between the prostate and rectum was intact and radical prostatectomy was performed successful. A watertight, urethrovesical anastomosis was performed with the single knot technique described as Van Velthoven technique. The peritoneum flap was fixed to the pelvic rim using 2/0 Vicryl. Final histopathology showed Gleason 5+5=10 tumour without lymph node metastasis. Cystography on the 7th postoperative day and the catheter was removed subsequently.
Conclusion: Non-metastatic prostate carcinomas with above-average prostate volume and very high PSA level are rarely described in the available literature. Despite the monstrous size and the advanced tumour stage, we were successfully able to perform radical prostatectomy. The patient recovered normally.

Robotic assisted radical prostatectomy of a very large (700ml) Adenocarcinoma of the prostate
04.11.2021Deutsch
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