Korean J Urol.  2009 Feb;50(2):97-104.

Robot-Assisted Laparoscopic Radical Prostatectomy

• Rha KH

Abstract

PURPOSE
Laparoscopic radical prostatectomy is an alternative to open prostatectomy in the surgical management of prostate cancer. The introduction of surgical robot to assist laparoscopic surgery served as a mechanical device to enhance the laparoscopic skills and improve surgical maneuverability with enhanced visual systems and the multi-axis articulating instruments. This review will introduce the evolution of surgical technique and current status of robotic-assisted laparoscopic prostatectomy.
MATERIALS AND METHODS
A review of literatures is conducted with the homepage of Korean Urologic Association and PubMed, a search tool of the National Library of Medicine and the National Institutes of Health, including the MEDLINE database.
RESULTS
After its approval by the United States FDA in 2000, the robotic technology has revolutionized the treatment of surgical management of prostate cancer. Robotic-assisted laparoscopic radical prostatectomy offers benefits of minimally invasive surgery with comparable oncological functional outcomes compared to standard surgical options.
CONCLUSIONS
This technique is expected to evolve into one of the standard of care in treatment of localized prostate cancer.

Keyword

Robotoices; Prostatectomy; Laparoscopy; Prostatic neoplasms

MeSH Terms

Laparoscopy
National Institutes of Health (U.S.)
National Library of Medicine (U.S.)
Prostatectomy
Prostatic Neoplasms
Standard of Care
United States

Figure

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  Fig. 1 Trocar placement for the transperitoneal approach. The letters represent the sequence of trocar placement. (A) Supraumbilical 12 mm camera port. (B, C) Eight mm ports for the robot instruments placed 8 cm laterocaudal to the camera port and 15 cm cranial to the pubis symphysis. (D) Eight mm ports for the 4th arm placed 8 cm laterocaudal to the B port in a direction toward the anterior superior iliac spine (ASIS). (E) Twelve mm port for an assistant instrument placed 8 cm laterocaudal to the C port in a direction toward the ASIS. (F) Five mm port for assistant's suction placed approximately 8 cm cranial to the midline of the A and C ports.

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  Fig. 2 Trocar placement for a small pelvis. The letters represent the sequence of trocar placement. (A) Supraumbilical 12 mm camera port. (B, C) Eight mm ports for the robot instruments placed 8 cm laterocaudal to the camera port and 15 cm cranial to the pubis symphysis. (D) Eight mm ports for the 4th arm placed 7 cm horizontal to the B port to avoid the anterior superior iliac spine (ASIS). (E) Twelve mm port for an assistant instrument placed 7 cm horizontal to the C port to avoid the ASIS. (F) Five mm port for assistant's suction placed approximately 8 cm cranial from the midline between the A and C ports.

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  Fig. 3 Bladder neck dissection. The picture demonstrates the left-side bladder neck dissection. The detrusor muscle fibers are identified and the lateral border of the bladder neck is separated until it reaches the seminal vesicle.

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  Fig. 4 Bladder neck transection. The picture demonstrates a well-preserved bladder neck. Following bilateral dissection of the bladder neck, the detrusor muscle is well appreciated. At this moment, the bladder neck is transected. This technique allows bladder neck preservation even for a prostate with a large median lobe.

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  Fig. 5 The da Vinci S Surgical system.

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