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Robot‐assisted partial prostatectomy for anterior prostate cancer: a step‐by‐step guide
Author(s) -
Villers Arnauld,
Flamand Vincent,
Arquímedes RodríguezCarlin,
Puech Philippe,
Haber GeorgesPascal,
Desai Mihir M.,
Crouzet Sebastien,
Ouzzane Adil,
Gill Inderbir S.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13785
Subject(s) - medicine , prostatectomy , prostate , enucleation , urethra , dissection (medical) , prostate cancer , surgery , urology , cancer
Objective To describe a step‐by‐step guide to robot‐assisted anterior partial prostatectomy ( RA ‐ APP ) for isolated magnetic resonance imaging ( MRI )‐detected anterior prostate cancer ( APC ). Patients and Methods After Institutional Review Board approval, over an 8‐year period (2008–2015), 17 consenting patients were enrolled in a prospective, single‐arm, single‐centre, Idea, Development, Evaluation, Assessment and Long‐term evaluation of innovative surgery ( IDEAL ) phase 2a study. The inclusion criteria comprised pre‐urethral, low–intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone ( TZ ) enucleation, and distal peripheral zone ( PZ ) sectioning; (ii) antegrade, at the bladder neck ( BN ) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. Results The RA ‐ APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN , prostate adenoma ( TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub‐montanal) urethra, and anterior BN . The posterolateral parts of the PZ and distal (sub‐montanal) urethra and peri‐prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien–Dindo grade II . RA completion of prostatectomy was feasible in the four cases with cancer recurrence. Conclusion PZ prostate‐sparing RA ‐ APP for isolated APC is feasible and safe, and represents an option for highly selected men with APC s as an alternative to other focal ablative therapy.