Surgical Hints for Robot-Assisted Transvesical Simple Prostatectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Benign prostatic hyperplasia (BPH) affects a significant portion of the aging male population.
• Surgical intervention is often required for symptomatic BPH, with simple prostatectomy being a common procedure.
• Advancements in robotic technology offer potential benefits for complex urological procedures.

Purpose of the Study:

• To present a detailed, step-by-step surgical technique for robot-assisted transvesical simple prostatectomy (RASP).
• To highlight key surgical hints and strategies to enhance the ease and efficiency of the RASP procedure.
• To evaluate the feasibility, safety, and initial functional outcomes of RASP for managing large prostate adenomas.

Main Methods:

• A standardized RASP technique was performed on 28 consecutive patients by a single surgeon.
• Key procedural steps included bladder detachment, endopelvic fascia exposure, longitudinal bladder neck incision, adenoma enucleation using Keith needles, hemostasis, trigonization, and double-layer bladder closure.
• The 'W' port configuration and specimen retrieval via the optical port incision were utilized.

Main Results:

• The study included 28 patients with a median prostate volume of 180 cm³.
• The procedure demonstrated low median blood loss (200 mL) and no intraoperative complications.
• Patients experienced significant improvements in urinary flow rate (Qmax), postvoided residual volume, and International Prostate Symptom Score (IPSS) post-surgery.

Conclusions:

• Robot-assisted transvesical simple prostatectomy (RASP) is a feasible, safe, and effective surgical option for treating large prostate adenomas.
• The technique facilitates the procedure and leads to favorable functional outcomes.
• Further prospective studies comparing RASP with alternative minimally invasive endoscopic techniques are warranted.