title: Robotic salvage retropubic prostatectomy after radiation/brachytherapy: initial results.
abstract: OBJECTIVE
  To report on the initial four patients who had robotic salvage retropubic prostatectomy (SRP) for biochemical recurrence after radiation therapy, and to review the surgical outcome of robotic cystoprostatectomy for bladder cancer in two patients who previously had prostate cancer.
  
  
  METHODS
  Since February 2006, four patients had SRP for biochemical failure after radiation and/or brachytherapy. Transrectal biopsy of the prostate confirmed locally recurrent disease and a metastatic evaluation including bone scan and computed tomography of the abdomen and pelvis were negative in all cases. The SRP was done using a six-port transperitoneal approach. An additional two patients had a robotic cystoprostatectomy for bladder cancer, in whom radiation was provided previously for prostate cancer. A retrospective analysis of the immediate and short-term surgical outcome was reviewed.
  
  
  RESULTS
  SRP was completed in all patients with no major complication or conversion to an open approach. The mean operative duration was 125 min, the mean (range) blood loss was 117 (50-250) mL and the mean hospital stay was 2.7 days. Of the four patients undergoing SRP, three had extracapsular extension and the first two had positive margins, while no patients had rectal injuries or significant blood loss. The lymph nodes were negative in all the patients. Three patients were continent within a month while one continued to use two to three pads/day at 3 weeks of follow-up. In the two patients who had cystoprostatectomy there were no major complications or increased surgical difficulty.
  
  
  CONCLUSIONS
  SRP is technically possible and with limited perioperative morbidity. Further studies are warranted to validate the oncological and functional outcomes of SRP after radiation and/or brachytherapy. Moreover, the robotic approach for radical cystoprostatectomy in patients who have had prostate radiation is feasible, with no increase in perioperative morbidity.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. kaoukj@ccf.org
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Jason
authors.initials: J
authors.lastname: Hafron
authors.forename: Rajk
authors.initials: R
authors.lastname: Goel
authors.forename: George-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D001918:Brachytherapy / Q000379:methods; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D016879:Salvage Therapy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy / Q000601:surgery*