Download FEASIBILITY AND OUTCOME OF ROBOT ASSISTED SYMPLE

FEASIBILITY AND OUTCOME OF ROBOT ASSISTED SYMPLE PROSTATECTOMY- OUR EARLY EXPERIENCE.
Federica Mazzoleni, Deliu-Victor Matei, Sara Melegari, Giacomo Galasso, Giovanni Cordima, Antonio
Brescia, Gennaro Musi, Danilo Bottero, Serena Detti, Ottavio de Cobelli
Divisione di Urologia, Istituto Europeo di Oncologia
Objectives:
The aim of this study is to evaluate outcome, feasibility and reproducibility of robot assisted approach for
high-volume symptomatic benign prostatic hyperplasia .
Patients & Methods:
From March 2009 to March 2012 two surgeons, robot experienced, performed a total of 39 consecutive
robot assisted simple prostatectomy (RASP) in patient with high volume prostatic hyperplasia. He used the
technique previously described by Sotelo.
Median prostate volume on preoperative TRUS was 99 ml. 25,7% of patients had indwelling catheter. Mean
IPSS was 28.
Results:
Median operative time was 178 minutes, average hospitalization was 3 days, while average catheterization
was 7 days. 25.1% of patients needed discontinuous or continuous catheter irrigation. Median blood loss
was 100 cc, none needed blood transfusion.
The average postoperative peak flow was 18.9 ml/s (p<0.001), while mean IPS-score was 7 (p<0.001).
Discussion:
When a surgical solution is chosen for patients with urinary obstructive symptoms, different parameters,
first of all prostate volume, are evaluated in order to select the approach allowing the best results.
The AUA and EAU guidelines suggest that open surgery should be the therapeutic choice when prostate
volume is higher than 80 ml. Incidence rates of open prostatectomy in developed countries are 12% to 40%
(in Italy: 29-32%).
However, well-recognized advantages as optimal functional results, short operation time, low rate
reoperation rates, no TURP syndrome are mainly overshadowed by disadvantages as longer catheterization
time, longer catheter irrigation time, higher blood loss requiring higher transfusion rates. These features
translate in longer hospital stay and, consequently longer convalescence.
For these reasons, stated that TURP is not an optimal choice for large volume obstructive prostates,
different minimally invasive approaches were proposed, as laser enucleation (HoLEP), laparoscopic and,
recently, robot assisted adenomectomy.
As far as costs are concerned, while robot assisted radical prostatectomy was clearly more expensive than
the open one, RASP turned out cheaper than the open simple prostatectomy basically due to the higher
costs of the hospitalization; TUR costs in large volume prostates patients were not much more convenient.
Conclusions:
RASP is a feasible and reproducible procedure; its outcome reveals advantages if compared with the open
or with other minimally invasive techniques (laser or laparoscopy). As a result, the robot assisted approach
seems to be interesting and worth for consideration in cases of high-volume prostate adenomas, too.
Extending the indication of this approach, to the simple prostatectomy, requires first that the surgeon have
had completed his robotic learning curve and second, as the incidence rate of high-volume symptomatic
benign prostatic hyperplasia is low, the opportunity to “see the procedure” becomes fundamental.