Robot-assisted Millin's retropubic prostatectomy: case series

Simple prostatectomy continues to be an effective surgical option for patients with symptomatic high volume benign prostatic hyperplasia. Recent trends towards minimally invasive urologic surgery, in particular for prostate cancer, have created surgical alternatives with additional potential benefits. We report on the feasibility of robot-assisted retropubic prostatectomy.

This series consists of three cases of simple prostatectomy performed through a robot-assisted retropubic (Millin) approach at two institutions. All patients had preoperative bothersome lower urinary tract symptoms with two patients presenting in urinary retention. Average preoperative transrectal ultrasound estimated prostate volume exceeded 300 cm3. All patients were ruled out for malignancy.

Average age for the patient group was 76.7 years with mean prostate specific antigen (PSA) of 25.1. Estimated blood loss averaged 558 ml (150-1125) and mean operative time was 211 minutes (178-230). One patient had a simultaneous inguinal hernia repair performed. The patient with the largest prostate required incision extension for removal of specimen. There were no acute intraoperative or perioperative complications. Mean hospital stay was 1.3 days and one patient required blood transfusion. Average adenoma weight was 301 grams (66-640). One patient developed bladder neck contracture several months postoperatively.

Robotic-assisted retropubic simple prostatectomy is a reasonable and safe alternative to an open technique. Faster recuperation and reduced blood loss are potential benefits to this approach. The longer operative time and extraction incision for very large prostates (>200 gms) may offset some of the advantages of the minimally invasive method.