Robot-assisted simple prostatectomy is a reasonable alternative to more complex, but less invasive, endoscopic procedures in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and severely enlarged prostate glands, according to researchers at the Center of Robotic Surgery in Chile.
The study, “Modified urethrovesical anastomosis during robot-assisted simple prostatectomy: Technique and results,” published in Prostate International, shows that open simple prostatectomy is still a suitable option and one that does not require advanced laparoscopic skills and a steep learning curve.
Given the high perioperative morbidity and long recovery times associated with open simple prostatectomy, newer and minimally invasive endoscopic techniques, including laparoscopic simple prostatectomy and holmium laser enucleation, have emerged in recent years as an alternative for the management of men with moderately enlarged prostates. These procedures are associated with lower blood loss and less pain, as well as shorter catheter times and hospital stays.
However, these procedures also require advanced laparoscopic skills, which take urologists longer times to master, preventing wider acceptance among urologists.
The robotic platform for open prostatectomy is not yet widely performed, but has emerged as an alternative. It provides increased magnification and better visualization, while facilitating in the more technically demanding steps of the prostatectomy procedure. In addition, it alleviates the stiff learning curve associated with complex minimally invasive reconstructive procedures.
Researchers described the results of robot-assisted simple prostatectomy (RASP) with a modified urethrovesical anastomosis (UVA) in a cohort of men with LUTS, all of whom had failed previous therapy with α-blockers and/or 5-α-reductase inhibitors. The study enrolled 34 patients, ages 62 to 74, with a median preoperative prostate volume of 117 cc, who were treated using RASP with UVA by a single surgeon.
Results showed that the procedure was effective and induced a significant improvement in the baseline international prostate symptom score (IPSS) and maximum urinary flow. The mean operative time was 96 minutes (range 78 to 126 minutes), and estimate blood loss was 200 mL, with two patients requiring blood transfusion. No conversion to open surgery was required.
In addition, the procedure was associated with an average hospital stay of 2.2 days, and average catheter times of 4.6 days, varying between 4 and 6 days.
No intraoperative complications were seen, but 20.5 percent of patients exhibited postoperative complications, with most being Grade II or lower in the Clavien scale.
Together, these results suggest that robot assisted prostatectomy with the modified urethrovesical anastomosis can be used in patients with enlarged prostates as an alternative to the more demanding laparoscopic procedures, the researchers concluded.