T. Rogers

Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe?

Robotic radical prostatectomy (RARP) is well established as a safe and effective treatment for prostate cancer. According to published studies, patients undergoing RARP are at increased risk of being diagnosed with an inguinal hernia after RARP and are four times more likely to have an inguinal hernia repair (IHR) following RARP. Several studies have demonstrated the effectiveness and safety of IHR during RARP. Overall, it has been observed that IHR adds on average, 12–15xa0min in total surgical time and there were no significant differences between RARP with or without IHR with respect to postoperative complications. This study analyzes a large series of patients undergoing RARP (1100) and compares them to a group that underwent RARP with IHR (39). Between December 2008 and January 2015, 1139 patients underwent RARP at Florida Hospital in Celebration, FL. Of the total patients, 39 underwent concomitant IHR. All procedures were performed by the same surgeons (urologist and general surgeon), using the same techniques of RARP and TAPP inguinal hernia repair. After 30xa0days, the differences were evaluated between groups regarding surgical time, EBL and postoperative complications. The average age of patients undergoing the procedure was 61.65xa0years. The mean procedure time was approximately 120xa0min (min), with an additional period of 68xa0min for IHR (meanxa0=xa0188; pxa0=xa00.0001). There was a significant difference in BMI between the groups, 28.3xa0kg/m2 for patients undergoing RARP and 26.8xa0kg/m2 for those who underwent RARP and IHR (pxa0=xa00.028). The EBL averaged 110.87xa0mL, with no significant difference between groups (pxa0=xa00371). There was no significant association between clinical stage of the patient and the type of procedure performed (pxa0=xa012:35). There was no significant difference in the presence of comorbidities and the operation preformed. There were 61 events recorded postoperatively, 57 (5.2%) among patients who underwent only RARP and 4 (10.26%) among those who had both. Taken together, the small amounts of complications in both groups prevent statistical significance. This study compared two groups of patients undergoing RARP: those with IHR and those without. Our study demonstrated an increase in surgical time; however, there was no increase in postoperative complications. From the data presented, we suggest that the performance of both procedures concomitantly is feasible and safe.

History and Development of Robotics in Urology

The first robot was designed and possibly constructed by Leonardo da Vinci around the year 1495. Leonardo’s robot is a nickname given to a humanoid automaton which is believed to be the result of Leonardo’s anatomical research in the Canon of Proportions as described in the Vitruvian Man (Fig. 20.1). The design notes for this model appear in sketchbooks that were rediscovered in the 1950s and this prototype was reconstructed in 2002 and was able to make several human-like motions, including sitting and moving its arms, neck and jaw [1] (Table 20.1).