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Transperitoneal robotic-assisted laparoscopic prostatectomy after prosthetic mesh herniorrhaphy
Costas D Lallas1, Mark L Pe, Jitesh V Patel
1Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. costas.lallas@jefferson.edu
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|August 8, 2009
Summary
Transperitoneal robotic-assisted laparoscopic prostatectomy (RALP) is feasible in men with prior mesh hernia repair. This approach offers comparable outcomes to patients without prior mesh placement, demonstrating safety and efficacy.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Prior prosthetic mesh herniorrhaphy presents unique challenges for subsequent radical prostatectomy.
- Assessing the feasibility of transperitoneal robotic-assisted laparoscopic prostatectomy (RALP) in this patient cohort is crucial.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transperitoneal RALP in patients with a history of prosthetic mesh herniorrhaphy.
- To compare the results with patients undergoing RALP without prior mesh placement.
Main Methods:
- Retrospective review of 309 patients undergoing transperitoneal RALP from October 2005 to January 2008.
- Analysis of a subgroup of 27 patients with prior mesh herniorrhaphy.
Main Results:
- No statistically significant differences in estimated blood loss, operative time, or length of hospital stay were observed between groups.
- The mesh herniorrhaphy cohort showed a lower percentage of organ-confined disease.
- Similar rates of margin status, one-year continence, and potency were found in both groups.
Conclusions:
- Transperitoneal RALP is a feasible surgical option for patients with prior prosthetic mesh herniorrhaphy.
- Critical steps include careful port placement and meticulous dissection to avoid mesh injury.
- Robotic surgery facilitates the management of complex cases, including those with prior mesh placement.
