Ali Riza Kural
Acibadem Maslak Hospital, Istanbul, Turkey
While open radical prostatectomy has been considered to be the gold standard for surgical treatment of clinically localized prostate cancer, robot-assisted radical prostatectomy (RARP) has gained popularity in recent years and become standard of care treatment in many centers.
Da Vinci robotic system provides 3D vision on the console and 6 degree freedom of movement of instruments which makes the reconstructive part easier. The main advantages of RARP are less blood loss, less pain, shorter catheter and hospital stay with improved oncological and functional results. However the cost is the major disadvantage.
Six ports are used during transperitoneal RARP : two 12mm ports for optic and assistant, three 8mm robotic ports and one 5mm assistant port. Procedure starts with the incision of peritoneum and entrance into the retzius space. Subsequently endopelvic fascia is opened and lateral dissection is carried out. Dorsal vein complex is controlled by a suture or endoGIA stapler. Then, anterior and posterior bladder neck dissection are performed. This is followed by apical dissection and urethral division. An approximation stitch is placed and the urethrovesical anastomosis is done finally.
The positive margin rates for pT2 disease differs from 5.7% to 19% in the published literature. Continence and potency rates are comparable to open and laparoscopic approach.
In our institution, 580 patients underwent RARP between 2005 and 2012.The oncological and functional outcomes are comparable to the major series. There were few perioperative and postoperative complications.