Advertisement

Robot-Assisted Laparoscopic Radical Prostatectomy: Management of the Difficult Case

  • Geoff Coughlin
  • Vipul R. PatelEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Robot-assisted laparoscopic radical prostatectomy (RALP) can present unique challenges to the entire operating team. While the level of complexity of individual cases can be difficult to estimate preoperatively, several patient characteristics and variations in prostate anatomy can indicate that intraoperative challenges are likely to be encountered. These include obese and morbidly obese patients, patients with prior major abdominal surgery, large prostate size, and the presence of a median lobe or prior transurethral resection of the prostate (TURP). This chapter outlines these and other challenging scenario encountered during RALP and illustrates the techniques we use to overcome them. The accompanying video gives narrated examples of these scenarios.

Keywords

Bladder Neck Median Lobe Ureteral Orifice Large Prostate Endopelvic Fascia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 6.1 Obese patients bmi 30 (12.6 MB)

Video 6.2 Prior laparotomy (14.5 MB)

Video 6.3 Post bilaterial inguinal mesh hernia repair (9.79 MB)

Video 6.4 Prior laparoscopic preperitoneal hernia repair (22.3 MB)

Video 6.5 Accessory pudendal (24.8 MB)

Video 6.6 Large prostate control of the dvc (25.1 MB)

Video 6.7 Difficult anatomy median lobe (24 MB)

Video 6.8 Difficult anatomy post turp (25 MB)

Video 6.9 Bladder neck reconstruction (21.9 MB)

References

  1. 1.
    Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO et al (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168(3):945–9PubMedCrossRefGoogle Scholar
  2. 2.
    Ahlering TE, Skarecky D, Lee D et al (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: Initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741PubMedCrossRefGoogle Scholar
  3. 3.
    Hugh JL, Thaly R, Shah K, Patel V. (2007) The advanced learning curve in robotic prostatectomy: a multi-institutional survey: AUA abstract, presented 05/20/07Google Scholar
  4. 4.
    Laungani RG, Kaul S, Muhletaler F et al (2007) Impact of previous inguinal hernia repair on transperitoneal robotic prostatectomy. Can J Urol 14(4):3635–9PubMedGoogle Scholar
  5. 5.
    Mulhall JP, Slovick R, Hotaling J et al (2002) Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile dysfunction. J Urol 167:1371–1375PubMedCrossRefGoogle Scholar
  6. 6.
    Rogers CG, Trock BP, Walsh PC (2004) Preservation of accessory pudendal arteries during radical retropubic prostatectomy: surgical technique and results. Urology 64:148–151PubMedCrossRefGoogle Scholar
  7. 7.
    Matin SF (2006) Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy. Urology 67:1012–1015PubMedCrossRefGoogle Scholar
  8. 8.
    Secin FP, Touijer K, Mulhall J et al (2007) Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol 51:1229–1235PubMedCrossRefGoogle Scholar
  9. 9.
    Zorn KC, Orvieto MA, Mikhail AA et al (2007) Effect of prostate weight on operative and postoperative outcomes of robotic-assisted laparoscopic prostatectomy. Urology 69(2):300–305PubMedCrossRefGoogle Scholar
  10. 10.
    Boczko J, Erturk E, Golijanin D et al (2007) Impact of prostate size in robot-assisted radical prostatectomy. J EndoUrol 21(2):184–188PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Florida HospitalCelebrationUSA

Personalised recommendations