Arroyo C, Carlos F, Galiano M, Barret E, Cathelineau X, Vallancien G

Language: Spanish
References: 11
Page: 374-379
PDF size: 86.29 Kb.

ABSTRACT

Introduction and objectives. Robot assisted radical prostatectomy is currently performed all over the world, although it was originally described using a transperitoneal approach, it can also be done extraperitoneally. We present a video of this technique. Material and methods. The patient is placed in a slight Trendelemburg position. The operation is divided in 8 critical steps: 1. The extraperitoneal surgical space is done and 5 trocars are placed. 2. Incision of the endopelvic fascia. 3. Santorini plexus ligation. 4. Bladder neck dissection. 5. Dissection of the vas deferens and seminal vesicules. 6. Prostatic pedicule resection and neurovascular bundule preservation. 7. Dissection of the dista urethra. 8. Urethro-bladder anastomosis. Results. We have done 105 robot assisted radical prostatectomies, in 70 a transperitoneal approach was used and in 35 the extraperitoneal modification was performed. Median intraoperative bleeding was 500cc with a 6% blood transfusion rate. We have never converted to open surgery, however two conversions to conventional laparoscopy due to technical difficulties and one due to a rectal injury have been done. The postoperative complications include: 2 hematomas and 1 abscess that required drainage. Conclusion. Robot assisted radical prostatectomy can be performed using the transperitoneal or extraperitoneal approach. The advantages and inconviniences are identical to those described in the literature for conventional laparoscopic prostatectomy.

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