title: Robot-assisted laparoscopic prostatectomy and previous surgical history: a multidisciplinary approach.
abstract: Previous abdominal or prostate surgery can be a significant barrier to subsequent minimally invasive procedures, including radical prostatectomy (RP). This is relevant to a quarter of prostatectomy patients who have had previous surgery. The technological advances of robot-assisted laparoscopic RP (RALP) can mitigate some of these challenges. To that end, our objective was to elucidate the effect of previous surgery on RALP, and to describe a multidisciplinary approach to the previously entered abdomen. One-thousand four-hundred and fourteen RALP patients were identified from a single-surgeon database. Potentially difficult cases were discussed preoperatively and treated in a multidisciplinary fashion with a general surgeon. Operative, pathological, and functional outcomes were analyzed after stratification by previous surgical history. Four-hundred and twenty (30 %) patients underwent previous surgery at least once. Perioperative outcomes were similar among most groups. Previous major abdominal surgery was associated with increased operative time (147 vs. 119 min, p < 0.001), as was the presence of adhesions (120 vs. 154 min, p < 0.001). Incidence of complications was comparable, irrespective of surgical history. Major complications included two enterotomies diagnosed intraoperatively and one patient requiring reoperation. All cases were performed robotically, without conversion to open-RP. There was no difference in biochemical disease-free survival among surgical groups and continence and potency were equivalent between groups. In conclusion, previous abdominal surgery did not affect the safety or feasibility of RALP, with all patients experiencing comparable perioperative, functional, and oncologic outcomes.
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, 625 Madison Avenue, 2nd Floor, New York, NY, 10022, USA.
authors.forename: Adrien N
authors.initials: AN
authors.lastname: Bernstein
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, 625 Madison Avenue, 2nd Floor, New York, NY, 10022, USA.
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Lavery
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, 625 Madison Avenue, 2nd Floor, New York, NY, 10022, USA.
authors.forename: Adele R
authors.initials: AR
authors.lastname: Hobbs
authors.affiliation: Department of General Surgery, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Chin
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, 625 Madison Avenue, 2nd Floor, New York, NY, 10022, USA. samadiroboticinstitute@gmail.com.
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
keywords: Outcomes assessment; Prostate cancer; Radical prostatectomy; Robotics; Tissue adhesion