Page 44 - Read Online

Falavolti et al. Early vascular control in robotic surgery

Catch bag. The Bulldog clamps on the internal iliac more popular especially for the treatment of medium-
arteries were removed; 2-0 monocryl running sutures small prostate adenomas, open simple prostatectomy
were used for cystotomy closure in two layers. The (OP) performed with either the Millin (retropubic) or the
prostatic fossa was then “trigonized” according to the Freyer (open transvesical) technique is still an effective
technique described by Sotelo suturing the posterior and reliable procedure for prostates > 80 mL. Holmium
[9]
[7]
edge of the bladder neck to the posterior edge of the laser enucleation of prostate (HoLEP) is seen as
urethra. An 18 French three-way Dufour catheter was close rival of TURP. [10,11] This procedure is showing
placed and the balloon inflated to 30 mL. Finally, we good results in terms of blood loss, transfusion
tested the bladder suture for leaks. We placed one rates, and a hospital stay at the expense of longer
drainage in the pelvis behind the bladder. The robotic operative time and postoperative dysuria. Despite its
arms were removed under vision and the abdominal invasive nature, simple prostatectomies represent the
wall was closed. 14-32% of all invasive procedures performed for BPH
in Europe. Open procedure is often preferred in
[12]
RESULTS men who have a concomitant bladder condition, e.g.
symptomatic bladder diverticulum, bladder calculus or
The demographics preoperative clinical data are inguinal hernia. Yet the disadvantages of open simple
showed in the Table 1. Patients’ median age was 74 prostatectomy compared with transurethral resection
(range 65-88). The median postoperative IPSS at are those of every open procedure such as the incision,
three months after surgery was 8 (range 3-13). The the higher estimate blood loss and the necessity of
median operative duration was 205 min (range 120-
300) and the median estimated blood loss (EBL)
was about 200 mL (range 100-350) irrespective of
prostate weight. The median temporary clamping of
internal iliac arteries duration average 12 min (range
11-14) during each adenoma’s enucleation that were
performed in about 10 min. The median prostate weight
on the pathological examination was 100 g (range 80-
195). Pathology revealed a benign glandular-stromal
hyperplasia in all patients. The abdominal drain
was removed on postoperative day 2. Continuous
postoperative catheter irrigation was maintained for
a median time of 41.5 h (range 18-55) in all patients.
The median hospital stay was 3.2 days (range 2-6).
The median catheter duration was 5.6 days (range
5-7). No patient required blood transfusion. Statistical
analysis was performed between the estimated blood
loss and the duration of continuous catheter irrigation.
The logistic linear regression showed a significant
statistical relation between these parameters (P =
0.0395) [Figure 3]. Furthermore, patients did not
present with symptoms of pelvic ischemia at the follow-
up four months after surgery. Figure 1: Port placement for simple prostatectomy. C: 12 mm
robotic camera port; 1,2,3: 8 mm robotic working ports; A 1 : 12 mm
DISCUSSION assistant port; A 2 : 5 mm assistant port
Table 1: Epidemiology and clinical data
Although the definition of “large prostate” is still unclear,
the surgical treatment of BPH is strictly dependent on Characteristics Median Range
74.3
Age (years)
65-88
prostate volume. For medium-size glands, transurethral Operative duration (min) 205 120-300
resection of the prostate (TURP) is considered the gold Ematic blood loss (mL) 200 100-350
standard. In fact, the EAU guidelines suggest TURP Catheterization (days) 5.6 5-7
[1]
Drainage (days)
2
2
for men with prostate sizes < 80 mL and moderate- Hospitalization (days) 3.2 2-6
to-severe lower urinary tract symptoms (LUTSs). Prostate weight (g) 100 80-195
[8]
Properly, a “large prostate” can be assumed as a gland Preoperative IPSS 25.2 16-38
8
3-13
Postoperative IPSS
> 80 mL. In these cases, the surgical treatment is still Continuous catheter irrigation (h) 41.5 18-55
controversial. Even though the lasers are becoming IPSS: International Prostatic Symptoms Score
Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017 37