Transvesical robotic radical prostatectomy.
OBJECTIVE
To report the technical feasibility of performing transvesical robotic radical prostatectomy (TRRP) in a cadaver.


METHODS
TRRP was performed in two fresh male cadavers (prostate volume 46 and 30 mL). In the first procedure we used four laparoscopic transvesical trocars and in the second a single-port device was placed percutaneously into the bladder. Pneumovesicum was established in both cases and the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the TRRP. All steps of the procedure, including dissection of the seminal vesicles and vas deferens, ligation of prostatic pedicles, release of neurovascular bundles, apical dissection, urethral transection, and urethro-vesical anastomosis, were done transvesically and robotically. Real time transrectal ultrasonography monitoring was used in the first cadaver.


RESULTS
Both procedures were technically successful transvesically with no need for additional ports or conversion to standard laparoscopy. The operative duration for the multi-port procedure was 3 h and for the single-port procedure was 4.2 h. Clashing of the da Vinci arms was the primary technical difficulty with the single-port procedure, but did not occur in the multi-port procedure.


CONCLUSIONS
TRRP under pneumovesicum is technically feasible using multiple-port or a single-port approach in the cadaver. The clinical application of this novel approach is imminent. Further refinement of technique and instruments might lead to an increasing role of percutaneous intraluminal surgery in various surgical disciplines.
Desai
Mihir M
MM
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. desaim1@ccf.org
Aron
Monish
M
Berger
Andre
A
Canes
David
D
Stein
Robert
R
Haber
Georges-Pascal
GP
Kamoi
Kazumi
K
Crouzet
Sebastien
S
Sotelo
Rene
R
Gill
Inderbir S
IS
D002102:Cadaver; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D012371:Robotics; D012669:Seminal Vesicles / Q000601:surgery; D014649:Vas Deferens / Q000601:surgery