The expansion of the indications of robotic technology let robot-assisted simple prostatectomy enter in the scenario of the surgical treatment of large benign prostatic hyperplasia (BPH).
In this video we present our technique of Robotic-Assisted “urethral-sparing” Simple Prostatectomy, that we named “pure adenomectomy”.
Since August 2017 15 patients with large BPH (prostate > 80 mL), significant Bladder Outlet Obstruction (BOO) and indication for BPH surgery were enrolled in this study. Patients found with significant median lobe at trans-rectal ultrasonography were excluded.
Demographic and perioperative variables, early (within 30 days) functional results were recorded and analysed.
Surgical technique. A transperitoneal, six ports approach was chosen. After the prostate gland is prepared, a transversal, anterolateral incision of the capsule is made halfway between the Dorsal Venous Complex (DVC) and the bladder neck. The cleavage plane between the surgical capsule and the adenoma is identified anteriorly and gently dissected at the level of prostate apex bilaterally. Once the left lobe is mobilized a median longitudinal incision is made at the level of anterior commissure. The urethra is medialized by suction device and gently dissected from the left lobe. At the end of this step the left lobe is removed. The procedure is repeated for the right lobe. Thus the urethra is spared inside the prostatic lodge. A hydro-distention test is performed to verify the urethral and bladder neck integrity. Prostatic capsule is then barbed sutured.
Robot-assisted “pure” adenomectomy was completed in 12 patients. In these patients mean age was 65 years, mean prostate volume was 130 cc, 2 patients had urethral catheter due to urinary retention. Operative time was 95 minutes; blood losses were 200 mL. No intraoperative complications occurred. Bladder irrigation was stopped 24 hours after surgery in all the cases. Catheterization time and hospital stay were 3 and 4 days, respectively. No complications at catheter removal. All the patients who were sexually active before the intervention (8) resumed their activity within 2 weeks after surgery with ejaculation maintained in all patients. At 1 month time point the “trifecta outcome” (combination of International Prostate Symptom Score <8, Qmax > 15 mL/s, and no perioperative complications) was reached in all patients.
The Robot-Assisted “Pure” Adenomectomy seems to be safe and effective in the treatment of large prostatic adenomas. In our preliminary experience, this procedure seems to represent the way to solve the bladder outlet obstruction and maintain a normal sexual function. Further studies with larger population and longer follow up are needed to confirm these preliminary findings