Perineal robot-assisted laparoscopic radical prostatectomy: feasibility study in the cadaver model.
OBJECTIVE
To evaluate the feasibility of perineal robot-assisted laparoscopic radical prostatectomy (P-RALP) in the cadaver model.


METHODS
The prostate was assessed by ultrasonography and cystoscopy in the lithotomy position. After incision and subcutaneous dissection, a single-port device was placed and the robot was docked. The rectourethralis muscle was divided and the levator ani fibers were split. The Denonvilliers fascia was incised and the posterior prostate and seminal vesicles were dissected. The apex was dissected and the urethra was transected. The anterior and lateral planes were dissected and the prostate pedicles were clipped. The prostate was freed from the bladder neck and the vesicourethral anastomosis was performed. The robot was undocked and the wound was sutured in layers. Cystoscopy confirmed integrity of the anastomosis. The specimen was sent for histopathology examination.


RESULTS
Nerve-sparing P-RALP was successfully completed in three cadavers. Median time for setting was 23 minutes. Time for posterior dissection was 15 minutes. Dissection of the apex and section of the urethra took 9 minutes. Time for anterolateral dissection was 14 minutes. Time for bladder neck dissection was 7 minutes. Vesicourethral anastomosis took 8 minutes. Total operative time was 89 minutes. The prostate capsule was grossly intact and histopathology examination was negative for prostatic tissue in all distal urethral sections and in two of three bladder neck sections.


CONCLUSIONS
P-RALP is feasible in the cadaver. Future studies should evaluate the feasibility of lymph node dissection through the same incision, clinical feasibility, and prospective comparisons with standard techniques.
Center for Laparoscopic and Robotic Surgery , Urology, Cleveland Clinic, Cleveland, Ohio.
Humberto
H
Laydner
Oktay
O
Akça
Riccardo
R
Autorino
Remi
R
Eyraud
Homayoun
H
Zargar
Luis Felipe
LF
Brandao
Ali
A
Khalifeh
Kamol
K
Panumatrassamee
Jean-Alexandre
JA
Long
Wahib
W
Isac
Robert J
RJ
Stein
Jihad H
JH
Kaouk
D015992:Body Mass Index; D002102:Cadaver; D003558:Cystoscopy / Q000379:methods; D004210:Dissection / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008953:Models, Anatomic; D061646:Operative Time; D010502:Perineum / Q000601:surgery*; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery