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Transvesical robotic radical prostatectomy
Author(s) -
Desai Mihir M.,
Aron Monish,
Berger Andre,
Canes David,
Stein Robert,
Haber GeorgesPascal,
Kamoi Kazumi,
Crouzet Sebastien,
Sotelo Rene,
Gill Inderbir S.
Publication year - 2008
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/j.1464-410x.2008.08004.x
Subject(s) - medicine , port (circuit theory) , neurovascular bundle , surgery , dissection (medical) , prostatectomy , cadaver , laparoscopic radical prostatectomy , laparoscopy , anastomosis , prostate , cancer , engineering , electrical engineering
OBJECTIVE To report the technical feasibility of performing transvesical robotic radical prostatectomy (TRRP) in a cadaver. MATERIALS AND METHODS TRRP was performed in two fresh male cadavers (prostate volume 46 and 30 mL). In the first procedure we used four laparoscopic transvesical trocars and in the second a single‐port device was placed percutaneously into the bladder. Pneumovesicum was established in both cases and the da Vinci‐S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the TRRP. All steps of the procedure, including dissection of the seminal vesicles and vas deferens, ligation of prostatic pedicles, release of neurovascular bundles, apical dissection, urethral transection, and urethro‐vesical anastomosis, were done transvesically and robotically. Real time transrectal ultrasonography monitoring was used in the first cadaver. RESULTS Both procedures were technically successful transvesically with no need for additional ports or conversion to standard laparoscopy. The operative duration for the multi‐port procedure was 3 h and for the single‐port procedure was 4.2 h. Clashing of the da Vinci arms was the primary technical difficulty with the single‐port procedure, but did not occur in the multi‐port procedure. CONCLUSIONS TRRP under pneumovesicum is technically feasible using multiple‐port or a single‐port approach in the cadaver. The clinical application of this novel approach is imminent. Further refinement of technique and instruments might lead to an increasing role of percutaneous intraluminal surgery in various surgical disciplines.