Die roboterassistierte laparoskopische radikale Prostatektomie

Prospective comparison between the AirSeal® System valve-less Trocar and a standard Versaport™ Plus V2 Trocar in robotic-assisted radical prostatectomy

BACKGROUND AND PURPOSE

To prospectively compare the AirSeal® System valve-less Trocar with a standard Versaport™ Plus V2 Trocar as assistant insufflating port in transperitoneal and extraperitoneal robotic-assisted radical prostatectomy (t-RARP/e-RARP).

PATIENTS AND METHODS

Two consecutive cohorts of patients undergoing RARP using either a 12 mm AirSeal valve-less Trocar (n=19 [14 t-RARP/5 e-RARP]) or a 12 mm Versaport Plus V2 Trocar (n=17 [11 t-RARP/6 e-RARP]) were prospectively evaluated. Age, body mass index, tumor characteristics, and surgical approach were similar in both cohorts. Besides relevant clinical data, episodes of pressure loss (<8 mm Hg), the number of necessary trocar manipulations, the frequency of camera cleaning, and overall carbon dioxide (CO2) consumption were recorded and compared.

RESULTS

Mean surgical time was 175 minutes in the AirSeal and 166 minutes in the Versaport group (p=0.55). Whereas in the AirSeal group, only one episode of pressure loss <8 mm Hg was observed; this occurred in mean 38 times in the Versaport group (p<0.0001). No trocar manipulations for specimen or needle retrieval were necessary in the AirSeal group in contrast to in mean 15 in the Versaport group (p<0.0001). Otherwise, no appreciable differences regarding overall operating time, blood loss, camera cleaning, or overall CO2 consumption were observed for the present study. Patient CO2 absorption was not evaluated.

CONCLUSIONS

In the present study, the AirSeal Trocar offered a more stable pneumocavity and facilitated specimen retrieval and needle extraction.

Contemporary radical prostatectomy

Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

Robotic-assisted radical prostatectomy in 2010

This article reviews the current status of robotic-assisted radical prostatectomy (RARP) with outcome analysis. The published English literature (PubMed) database was searched extensively for major publications and large series on RARP. The search was carried out over the preceding 3-year period. Selected series were then reviewed, summarized and analyzed for their salient features. A literature search yielded 19 major publications on RARP in the preceding 2 years. A review of the current RARP literature (2006-2009) of multi-institutional cases of RARP demonstrated a mean operating room time, blood loss, hospital stay, positive surgical margin rate and perioperative-complication rate of approximately 194 min, 196 ml, 1.43 days, 25.7% and 5.83 %, respectively (based on the analysis of data using central tendency measures [mean]). The overall potency and continence rates were 73.6 and 87.1%, respectively (based on analysis of the published and reported data). All RARP cases were performed with the use of da Vinci robotic system (Intuitive Surgical, CA, USA). It is expected that in 2010 close to 70% of radical prostatectomies in the USA will be performed with robotic assistance. The patient and surgeon appeal for RARP continues to expand exponentially. It seems pertinent to conclude that increasing experience with RARP may reduce the incidence of positive surgical margins and will improve the functional outcome, which is the challenge at this point in time. Although the early cancer control and intermediate follow-up on functional outcome with RARP appears to be convincing and favorable, the long-term ( approximately 10 years) data are still awaited.