Robot-assisted simple prostatectomy

Sandi Poteko, urologist, Dept. of Urology, GH Celje, Slovenia

Treatment of patients with very enlarged prostate and symptoms of obstructed BPH is a challenge. Open prostatectomy (adenomectomy) is the oldest procedure for treatment of patients with symptomy of BPH. Minimally invasive surgery includes laparoscopic simple prostatectomy and robot-assisted simple prostatectomy (RASP).

Materials and methods
Between 2015 and 2017 a RASP was performed in 9 patients with average age 69 years (52-82 years). The average volume of enlarged prostate was 145 ccm (105-185 ccm). Indications for RASP were urinary retention in 6 patients, repeated haematuria and stones in a bladder in 2 patients and hydronephrosis with renal function impairment in one patient. RASP was performed with DaVinci S HD. After creating a pneumoperithoneum, 5 troacars were inserted in the same position as used for RARP. Longitudinal incisio of the bladder wall was created between four stay sutures. After identification of both orificies a plane between adenomas and surgical capsule was found. Adenomectomy was done with blunt and sharp dissection. Stones were removed from the bladder. A V-lock suture was used for haemostasis and trigonisation. A catheter Ch 24 was inserted and a cystotomy was closed with V-lock suture.

Follow-up was between 8 and 34 months. All RASP were performed by one console surgeon (S. P.). Console time was 130-190 minutes. Estimated blood lose was 600-2000 ml. Blood transfusion was used for two patients. After the removal of robotic ports and problems with bleeding we decided for open revision in one patient. Postoperative hospital stay was 3-7 days. Urinary catheter was removed on 7th- 21th day (average 14th day). Average weight of removed adenomas was 86 gr.(45-145 gr.). One patient’s PH report contained a focus (2mm) of prostate cancer, GS 6. Before RASP his PSA was 1,1 ng/ml. There was no urinary retention after catheter removal and no readmittance in 90 days. Average PSA after 6 to 12 months was 0,43 ng/ml. Q max. after 6 months was 17-45 ml/s in 8 patients. One patient had Q max. 3ml/s after 6 months. Internal urethrotomy was performed because of urethral stricture.

RASP is an alternative to open adenomectomy in some high volume centers. Surgeon’s experience with RARP is very important. Results of RASP in the literature include low rate of complications and good functional results. Most results are from retrospective studies with small number of patients. Additional studies and comparative studies with endoscopic treatments are needed. The group of our patients is too small to conclude.