Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 2 • CUTTING EDGE - UROLOGY The type of surgery recommended to the patient will depend on patient and prostate anatomy, patient comorbidities, surgeon’s experience and training. Transurethral resection of the prostate (TURP) remains the gold standard for the treatment of prostates less than 80 g, and open simple prostatectomy (OSP) has been the gold standard for the treatment of prostates larger than 80 g [2]. However, OSP is associated with a significant risk for complications [3, 4]. In 2002, laparoscopic simple prostatectomy was first described as a minimally invasive alter- native to OSP to reduce perioperative complications, especially blood loss, blood transfusions, reoperation, and to decrease the length of hospital stay [5–7]. Robotic simple prostatectomy (RSP) was first described in 2008 and since then its role for surgical treatment of BPH is increasing [8, 9]. Using robotics has demonstrated benefit in providing stereoscopic magnified 3-D vision, tremor filtration, seven degrees of freedom wristed instruments, and enhanced ergonomics. The benefits of these have resulted in a shorter learning curve for RSP than for laparoscopic simple prostatectomy [4]. We have previously reported on our experience of using the transperitoneal approach [4, 10]. The transperitoneal approach is usually preferred, which is reflective of the sur- geon’s background experience with robotic radical prostatectomy. Preoperative Preparation Preoperative Evaluation Preoperative evaluation includes history, physical examination, digital rectal exam (DRE), and laboratory testing including kidney function tests, urinalysis, reflex culture, and prostate-specific antigen (PSA). We also administer the International Prostate Symptom Score (IPSS) and Sexual Health Inventory for Men (SHIM) questionnaires, and obtain uroflowmetry with peak flow rate (Qmax) measurement, transrectal ultrasound to estimate prostate size, and perform a bladder scan to assess post-void residual volume. A transrectal prostate biopsy is performed, to rule out prostate cancer, if the patient has an elevated PSA or abnormal DRE, if clinically indicated. Patients are counseled as to all treatment alternatives and surgical options. Risks and benefits, potential complications, and the possibility of conversion to open surgery are discussed. Informed consent is obtained. Antiplatelet and anticoagulant medications are discontinued or bridged before surgery, as clinically indicated. Medical and anesthesia clearance are obtained if necessary. No bowel prepa- ration is us ually required unless t he patient is habitually constipated, and the patient is made NPO after mi dnight on the day of surgery. Prophylactic intravenous antibiotics are administered at induction of a nesthesia pr ior to skin incision and are usually discontinued 24 h after surgery. Operative Room Setup For RSP, we use a four-arm robotic technique. The additional arm allows for the need of only one assistant who is positioned on the patient’s left side. The scrub technician is positioned on the patient’s left side as well with video monitors on both sides of the patient for easy viewing by the Cutting EDGE_Urology(SUN)_final.indd 2 27-Mar-18 10:00:26 AM