Esequiel Rodriguez

Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing

To analyse the impact of a ≈50% reduction of cavernous nervous tissue on the qualitative and quantitative recovery of sexual function after unilateral (UNS) and bilateral (BNS) nerve‐sparing robotic radical prostatectomy (RALP), by evaluating these differences in two groups treated with cautery and a cautery‐free technique (CFT).

Zero positive surgical margins after radical prostatectomy: is the end in sight?

Positive surgical margins represent incomplete resection by the surgeon, and elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the ‘Holy Grail’ of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology to the da Vinci® robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

Salvage robot-assisted radical prostatectomy with pelvic lymph node dissection after cryotherapy failure

We report the first case of post-cryotherapy salvage radical prostatectomy for local recurrence performed laparoscopically with the da Vinci robot. Total operative time was 210 minutes and blood loss was 50ml. There were no intraoperative or postoperative complications. The hospital stay was 24 hours and the Foley catheter was removed on postoperative day 7. The patient achieved a pad free status 4 weeks postoperatively. Pathology showed extensive disease, pT3bN0, Gleason score of 5+3 and positive margins. The patient continued on complete androgen deprivation therapy and his follow up PSA at 10 months was <0.1. Further studies are needed to evaluate both functional and oncological results with this approach.

Nerve-sparing techniques in open and laparoscopic prostatectomy.

Open and laparoscopic radical prostatectomy is a safe and effective treatment for organ-confined prostate cancer with excellent cancer control and quality of life outcomes. We present current nerve-sparing techniques used in open, laparoscopic and robot-assisted prostatectomy to maximize postoperative potency. We review the literature and describe important anatomical landmarks and technical aspects that differentiate between approaches. Nerve trauma is inherent to the surgery and cannot be completely avoided. These techniques serve to minimize injury without compromising oncologic outcomes. In combination with postoperative pharmacological and mechanical recuperative approaches, nerve-sparing surgery has made an impact in postprostatectomy quality of life.

Outcome Measures After Robot-assisted Laparoscopic Prostatectomy

Prostate cancer is the third most common cancer in men, with half a million new diagnosis worldwide yearly [56]. Prostate cancer accounts for approximately 10% of all male cancers and is the second most frequent cause of cancer death in men [38]. Radical retropubic prostatectomy (RRP) remains the gold standard treatment for organconfined disease. Presently, most open radical prostatectomies are performed using the anatomical principles described by Walsh and Donker [76] and Walsh et al. [77] which have significantly reduced morbidity and mortality and improved postoperative continence and potency. To further reduce postoperative morbidity and improve convalescence, there is increasing interest in the application of laparoscopy in oncology. Laparoscopy has the potential for decreasing surgical morbidity, postoperative pain and narcotic use, blood loss, length of hospital stay, and improve cosmesis and convalescence from smaller incisions compared with open surgical approaches.

Vascular Pedicle Control During Robot-Assisted and Laparoscopic Prostatectomy: Bulldog Clamp and Suturing Technique

THE OBJECTIVE of nerve-sparing radical prostatectomy is complete removal of the prostate without injuring or transecting the delicate neurovascular bundles (NVBs) that are intimately and variably related to the lateral, posterolateral, and posterior surfaces of the prostate. Electrocautery (monopolar, bipolar, harmonic energy) is known to cause thermal injury to nearby neural tissue and is associated with decreased erectile response to cavernous nerve stimulation.1 As such, complete avoidance of any thermal or electrical energy during lateral pedicle transection and NVB release is essential during nerve-sparing procedures. This can be accomplished effectively with bulldog clamps and delicate, specific suture ligation.

Prostatectomía radical robótica: resultados oncológicos

OBJECTIVES To review the current literature on oncologic outcomes following robot-assisted laparoscopic radical prostatectomy. METHODS A systematic MEDLINE search was performed to retrieve articles relating to oncologic outcomes with robot-assisted laparoscopic prostatectomy. Two reviewers independently selected studies, assessed their methodological quality and extracted data. RESULTS Positive surgical margin rates in RALP are commensurate to contemporary open and standard laparoscopic series. Surgical experience and refinement of technique helped decrease positive margins. Long-term biochemical disease-free survival (PSA 12 month follow-up. CONCLUSIONS RALP is a safe and reproducible treatment modality for organ-confined prostate cancer and provides excellent short-term oncological control. Larger studies with long-term oncologic follow-up are needed to establish the efficacy compared to more traditional surgical approaches.