Extraperitoneal robot-assisted laparoscopic radical prostatectomy: Initial experience

Prem Nath Dogra, Ashish Kumar Saini, Prabhjot Singh, Girdhar Bora, Brusabhanu Nayak, Prem Nath Dogra, Ashish Kumar Saini, Prabhjot Singh, Girdhar Bora, Brusabhanu Nayak

Abstract

Objectives: To report our initial experience and technique of performing robot-assisted laparoscopic radical prostatectomy (RALP) with the extraperitoneal approach.

Materials and methods: Twenty-seven patients, between September 2010 to January 2012, were included in the study. All patients underwent extraperitoneal robot-assisted radical prostatectomy. Patients were placed supine with only 10-15(0) Trendelenburg tilt. The extraperitoneal space was developed behind the posterior rectus sheath. A five-port technique was used. After incision of endopelvic fascia and ligation of the deep venous complex, the rest of the procedure proceeded along the lines of the transperitoneal approach.

Results: The mean patient age, prostate size and Gleason score were 67 ± 1.8 years, 45 ± 9.55 g and 6, respectively. The mean prostate-specific antigen (PSA) was 6.50 ng/mL. The mean time required for creating extraperitoneal space, docking of robot and console time were 22, 7 and 94 min, respectively. The mean time to resume full oral feeds was 22 ± 3.45 h. There were no conversions from extraperitoneal to transperitoneal or open surgery in our series. Pathological stage was pT1, pT2a and pT3b in 11 (40.74%), 14 (51.85%) and two (7.4%) patients, respectively. Two patients had positive surgical margins and two had biochemical recurrence at the last follow-up. Our mean follow-up was 12 ± 3.30 (2-17) months. The overall continence rate was 83.33% and 92.4% at 6 and 12 months, respectively.

Conclusions: Extraperitoneal RALP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate.

Keywords: Carcinoma prostate; extraperitoneal; prostatectomy; robotics.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
(a) A 1.5 cm transverse skin incision to the right side of the umbilicus, 20 cm from the superior margin of the symphysis pubis. (b) The anterior rectus sheath is incised (arrow). (c) Extraperitoneal space, arrow indicating epigastric blood vessels. (d) External view following placement of the five ports
Figure 2
Figure 2
(a) Ligation of the deep venous complex. (b) Incision of endopelvic fascia. (c) Posterior dissection, both seminal vesicles being lifted anteriorly. (d) Vesico-urethral anastomosis over a Foleys catheter

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