The pubovesical complex-sparing technique on laparoscopic radical prostatectomy
Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. A 61-year-...
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Published in | International Brazilian Journal of Urology Vol. 44; no. 4; pp. 844 - 845 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Brazil
Sociedade Brasileira de Urologia
01.07.2018
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Subjects | |
Online Access | Get full text |
ISSN | 1677-5538 1677-6119 1677-6119 |
DOI | 10.1590/s1677-5538.ibju.2017.0359 |
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Abstract | Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution.
A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed.
The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection.
The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes. |
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AbstractList | Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution.
A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed.
The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection.
The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes. ABSTRACT Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes. |
Author | Britto, Cesar Araujo Monteiro, Rodrigo Campos Lima, João Paulo Pereira Almeida, Filipe de Pádua B. F. Rebouças, Rafael Batista Passerotti, Carlo Machado, Marcos Tobias |
Author_xml | – sequence: 1 givenname: Rafael Batista surname: Rebouças fullname: Rebouças, Rafael Batista organization: Hospital da Polícia Militar Edson Ramalho, Brasil; Universidade de João Pessoa - UNIPE, Brasil; Hospital São Vicente de Paulo, Brasil – sequence: 2 givenname: Rodrigo Campos surname: Monteiro fullname: Monteiro, Rodrigo Campos organization: Hospital da Polícia Militar Edson Ramalho, Brasil; Hospital São Vicente de Paulo, Brasil – sequence: 3 givenname: João Paulo Pereira surname: Lima fullname: Lima, João Paulo Pereira organization: Hospital da Polícia Militar Edson Ramalho, Brasil – sequence: 4 givenname: Filipe de Pádua B. F. surname: Almeida fullname: Almeida, Filipe de Pádua B. F. organization: Hospital da Polícia Militar Edson Ramalho, Brasil – sequence: 5 givenname: Cesar Araujo surname: Britto fullname: Britto, Cesar Araujo organization: Universidade Federal do Rio Grande do Norte, Brasil – sequence: 6 givenname: Marcos Tobias surname: Machado fullname: Machado, Marcos Tobias organization: Faculdade de Medicina do ABC, Brasil – sequence: 7 givenname: Carlo surname: Passerotti fullname: Passerotti, Carlo organization: Hospital Alemão Oswaldo Cruz, Brasil; Laboratório de Investigação Médica, Brasil |
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SubjectTerms | Adenocarcinoma - surgery Humans Laparoscopy - methods Male Middle Aged Operative Time Organ Sparing Treatments - methods Prostatectomy - methods Prostatic Neoplasms - surgery Reproducibility of Results Treatment Outcome Video Section |
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Title | The pubovesical complex-sparing technique on laparoscopic radical prostatectomy |
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