Arnauld Villers1, Vincent Flamand1, Rodríguez-Carlin Arquímedes2, Philippe Puech3, Georges-Pascal Haber4, Mihir M Desai5, Sebastien Crouzet6, Adil Ouzzane1, Inderbir S Gill5. 1. Department of Urology, CHU Lille, Université de Lille, Lille, France. 2. Clinica INDISA, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile. 3. Department of Radiology, CHU Lille, Université de Lille, Lille, France. 4. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 5. USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA. 6. Urology and Transplantation Department, Edouard Herriot Hospital, Université de Lyon, Lyon, France.
Abstract
OBJECTIVE: To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). PATIENTS AND METHODS: After Institutional Review Board approval, over an 8-year period (2008-2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. RESULTS: The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien-Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. CONCLUSION: PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.
OBJECTIVE: To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). PATIENTS AND METHODS: After Institutional Review Board approval, over an 8-year period (2008-2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. RESULTS: The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien-Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. CONCLUSION: PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.
Authors: Walter L Biffl; David A Spain; Angelique M Reitsma; Rebecca M Minter; Jeffrey Upperman; Mark Wilson; Reid Adams; Edward B Goldman; Peter Angelos; Thomas Krummel; Lazar J Greenfield Journal: J Am Coll Surg Date: 2008-04-24 Impact factor: 6.113
Authors: Francesco Montorsi; Timothy G Wilson; Raymond C Rosen; Thomas E Ahlering; Walter Artibani; Peter R Carroll; Anthony Costello; James A Eastham; Vincenzo Ficarra; Giorgio Guazzoni; Mani Menon; Giacomo Novara; Vipul R Patel; Jens-Uwe Stolzenburg; Henk Van der Poel; Hein Van Poppel; Alexandre Mottrie Journal: Eur Urol Date: 2012-06-07 Impact factor: 20.096