Techniqe of Robotic Prostatectomy - Cornell Total Reconstruction Technique - Dr. Ash Tewari

For more information about prostate cancer treatment and robotic prostatectomy, visit my homepage: http://www.nycrobotics.com

Abstract

Background and Purpose: Creation of an optimally apposed, tension-free, well-supported vesicourethral anastomosis remains the cornerstone for anastomotic healing after radical prostatectomy. We report the effect of three techniques of bladder neck reconstruction during robot-assisted radical prostatectomy on anastomotic leak, stricture formation, and continence recovery.

Patients and Methods: Between January 2005 to September 2009, 1900 consecutive patients underwent robotic assisted laparoscopic prostatectomy (RALP) by a single surgeon. Of these, the first 214 underwent vesicourethral conventional anastomosis (CA); the next 303 men underwent anterior reconstruction (AR) only; and last 1383 men underwent total anatomic restoration (TR). Data elements included patient age, body mass index, preoperative biopsy Gleason score and prostate-specific antigen level, prostate volume, total operative time, console time, time for performing vesicourethral anastomosis, estimated blood loss, tumor stage, and margin status on final pathologic findings. Primary end points were rates of clinically significant anastomotic leaks, bladder neck contractures, and time to return of continence. Chi-square and Fisher exact tests were used for analysis of categorical variables. The Cox proportional hazard model was used for both univariate and multivariate analysis.

Results: Clinically significant anastomotic leakage and bladder neck strictures were significantly fewer in the reconstructed groups (2.3% vs. 1.0% vs. 0.3% and 3.7% vs. 1.3% vs. 0.5% in the CA, AR, and TR groups, P less than 0.01). Continence rates at 1, 6, 12, 26, and 52 weeks after RALP were also significantly better at all time points with AR and TR compared with CA alone (P less than 0.001).

Conclusions: TR of the continence mechanism optimizes vesicourethral anastomosis healing and hastens early continence return after RALP.


http://www.nycrobotics.com

email: ash.k.tewari@gmail.com

Dr. Ash Tewari is a professor of urology at Weill Cornell Medical College. He has performed over 3500 robotic prostate cancer surgeries. He is a NIH funded researcher for the development of real time imaging during prostate cancer surgery as well as a member of the NIH early detection research network. He serves as director of the Prostate Cancer Institute and the LeFrak Center for Robotic Surgery at Weill Cornell Medical College.
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Science & Technology

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