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Robot-assisted laparoscopic radical prostatectomy in the Asian population: modified port configuration and ultradissection

 Wooju Jeong  ;  Motoo Araki  ;  Sung Yul Park  ;  Young Hoon Lee  ;  Hiromi Kumon  ;  Sung Joon Hong  ;  Koon Ho Rha 
 INTERNATIONAL JOURNAL OF UROLOGY, Vol.17(3) : 297-300, 2010 
Journal Title
Issue Date
Aged ; Asian Continental Ancestry Group* ; Dissection/methods ; Humans ; Japan ; Laparoscopy* ; Male ; Pelvis/anatomy & histology ; Prostatectomy/methods* ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery* ; Robotics* ; Severity of Illness Index
Asia ; port configuration ; robot-assisted laparoscopic radical prostatectomy ; ultradissection
We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports were placed medially and caudally in patients with a small pelvis to avoid interference between the ports and the pelvis (modified port configuration). Lymph node dissection is carried out in the external iliac, obturator and infraobturator area. The dissection on the lateral border of the bladder neck is carried out until it reaches the seminal vesicle (ultradissection). After transection of the bladder neck, vasa seminal vesicles are dissected further. Neurovascular bundles are preserved in selected patients. The dorsal venous complex (DVC) and the urethra are transected without suturing. Urethrovesical anastomosis is carried out with 3-0 monocryl running suture, incorporating with the edge of DVC. The puboprostatic collar and bladder are incorporated by 3-0 monocryl running suture (puboperineoplasty). Between November 2007 and September 2008, RARP was carried out using this technique in 182 patients. Median height, weight, body mass index and prostate-specific antigen (PSA) were 168 cm, 68 kg, 24 kg/M(2) and 7.1 ng/mL, respectively. Mean operative time was 192 min and average blood loss was 250 mL. Median catheterization time was 8 days. Positive surgical margin rates for pT2, pT3 and pT4 disease was 12.7, 48 and 100%, respectively. Intraoperative complication rate was 2.7%. Fifty-five patients completed a minimum of 10 months follow up. Their continence rate was 91%. RARP is a safe and feasible surgical modality for prostate cancer among Asian patients with a small pelvis. Our technique achieves a precise bladder neck dissection
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Young Hoon(이영훈)
Jeong, Woo Ju(정우주)
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
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