Transvesical robot-assisted simple prostatectomy with 360° circumferential reconstruction: step-by-step technique

Abstract

Objective: To present the step-by-step technique of a 360° mucosal reconstruction after transvesical robot-assisted simple prostatectomy (RASP).

Patient and methods: We analysed the first 23 consecutive patients who underwent RASP using our 360° reconstruction between December 2015 and October 2017. After transperitoneal intravesical adenoma enucleation, a circumferential 360° reconstruction is performed. The first suture is placed at the 9 o'clock position and the edge of the urethra and bladder mucosa is approximated using 2-0 barbed suture. The reconstruction is continued counter-clockwise and the bladder mucosa is approximated to the urethra circumferentially.

Results: The mean (sd) operating time was 160.6 (28.1) min and the estimated blood loss was 98.6 (99.8) mL. No patients required conversion to open surgery. No intra-operative or postoperative transfusions were needed. No intra-operative complications occurred. The mean (sd) length of hospital stay was 2.1 (0.6) days. One postoperative complication was reported (respiratory distress in a patient with chronic obstructive pulmonary disease, requiring intensive care unit admission).

Conclusion: Our 360° reconstruction during RASP is feasible and safe. The aim of the technique is to minimize use of electrocautery and decrease the raw surface area on the prostate capsule. This technical modification could potentially lessen postoperative bleeding after RASP and therefore the need for continuous bladder irrigation. In addition, it could potentially lead to mitigation of burning and irritative postoperative symptoms. Longer follow-up and comparative studies of different RASP techniques are still needed.

Keywords: benign prostatic hyperplasia; prostatectomy; robot-assisted simple prostatectomy; robotics.