title: Descriptive Technique and Initial Results for Robotic Radical Perineal Prostatectomy.
abstract: To minimize technical challenges of radical perineal prostatectomy (RPP), we conceived and applied the robotic approach to this technique in an aim to improve surgical applicability of RPP. Radical prostatectomy via the perineal route, avoiding the intra-abdominal cavity, has been shown to be oncologically safe, with excellent functional outcomes and a short hospital stay. We report our initial results with this novel approach.
  
  
  
  We performed the procedure in 4 patients. With the patient in the exaggerated lithotomy position, following a 3 cm perineal incision, the initial perineal dissection using Belt's approach is performed, followed by single port placement and docking of the robot.
  
  
  
  The median age for patients was 64 years (60-69). Two patients had no rectum because of the abdominoperineal resection due to inflammatory bowel diseases. One of the other 2 patients had a surgical history of aborted robotic-assisted laparoscopic radical prostatectomy and 1 patient had no surgical history. There were no perioperative complications and the patients were discharged within 16-48 hours. Urethral catheter was removed within 10 days in 3 patients, and 3 weeks in 1 patient. Two patients were immediately continent when Foley was removed. The final pathology revealed focally positive margin in those 3 patients who had surgical histories and it was margin negative in the patient with native anatomy. All patients had undetectable prostate-specific antigen postoperatively.
  
  
  
  RPP was successfully completed in 4 cases, applying a single port robotic perineal approach. Initial results are encouraging, with short hospital stay and minimal postoperative pain.
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH. Electronic address: kaoukj@ccf.org.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Peter
authors.initials: P
authors.lastname: Caputo
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramirez
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Hiury
authors.initials: H
authors.lastname: Andrade
authors.affiliation: Department of Urology, Medipol University Hospital, Istanbul, Turkey.
authors.forename: Selami
authors.initials: S
authors.lastname: Albayrak
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.affiliation: Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Angermeier
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome