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VIDEO SESSIONS

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ID-05.03oncomitant Procedures Duringobotic Simple Prostatectomyotelo R1, Carmona O1, De Andrade R1,stigueta J1, Moreira O1, Ramirez D1,ernandez G1, Di Grazia E1, Canes D2

Instituto Medico La Floresta, Caracas,enezuela; 2Lahey Clinic Medical Center,urlington, MA, USA

ntroduction: Laparoscopic and robotic-ssisted simple prostatectomy has beenescribed. However, the presence of asso-iated pathology is traditionally an indica-ion to consider open simple prostatec-omy. We have recently performedobotic simple prostatectomy in the set-ings where ancillary procedures wereequired, including bladder diverticulec-omy and inguinal hernia repair.ethods: The first patient is a 64 year

ld man with large volume BPH and bilat-ral inguinal hernias. Serum PSA was 4.7g/ml, and transrectal prostate biopsy wasegative for carcinoma. Following simplerostatectomy, bilateral mesh herniorrha-hy was performed robotically, followedy retroperitonealization of the mesh. Theecond patient developed a large leftided bladder diverticulum from longas-anding bladder outlet obstruction. Ro-otic simple prostatectomy was precededy bladder diverticulectomy, guided byimultaneous flexible cystoscopy.esults: Operative time in case 1 was150in, and the pathologic specimen weightas 65 grams. The patient exhibited no

igns or symptoms of hernia recurrencer mesh infection postoperatively. Opera-ive time for case 2 was 120 min, with apecimen weight of 55 grams. Hospitaltay was 2 days in both cases, and no in-raoperative or postoperative complica-ions occurred.onclusion: Performing concomitant ro-otic repair of associated pathology dur-

ng robotic simple prostatectomy is safend feasible.

ID-05.04ptimization of Robotic Anatomicaladical Prostatectomy andreservation of Neurovascularundlesena J, Gausa L, Rosales A, Palou J,illavicencio Hundacio Puigvert, Barcelona, Spain

ntroduction and Objectives: Surgeryust be carefully planned, going step by

tep. This is an anatomical and safe wayf performing a correct approach fromhe very beginning. Following this princi-les, the procedure will be oncologically

orrect and very precise with the purpose w

162

o preserve the sphincter and the nerveshat are responsible of erectile function.a Vinci robotic technology contributesith 3D vision. Surgical precision, better

kills and improved ergonomics offer ad-antages for the quality of surgery. Weave introduced a 3D anatomical mapodel in order to improve and facilitate

urgery.aterials and Methods: The approach

ndertaken by Fundacio Puigvert is similaro open surgery, with some modificationso adapt prostate dissection to the Dainci robot. It has been applied in 250ases since July 2005. We present a casef radical prostatectomy treated with a 3Dnatomical map model.esults: The surgical technique with thea Vinci robot, is based on the anatomicalptimization offered by the robot’s visions well as on the precision of the instru-ents when preserving the sphincters

nd the neurovascular bundles. The sur-ery is based on athermal and gentle dis-ection. In this particular patient the oper-tive time was 1 hour and 50 minutes.lood loss: 125 cc. Pathology was: pT2b,leason 3�4, negative margins.onclusions: To facilitate sphincter andeurovascular bundles preservation weave developed 3D anatomical mapodel, which allows standardisation and

natomical optimization of the Da Vinciobotic radical prostatectomy, thus im-roving both the oncological and the

unctional results.

ID-05.05obotic Prostatectomy with Tensionree Neurovascular Bundle Dissectionnd Santorini Plexus Preservation: Aetter Surgical Alternative To Activeurveillance?ollins J, Fraga C, Asimakopoulos A,aston Rlinique Saint Augustin, Bordeaux,rance

ntroduction and Objective: The dainci robotic assisted laparoscopic radicalrostatectomy (RALP) is increasingly per-

ormed worldwide, however there is notandard technique and no consensus onow to best preserve the neurovascularundles. We report a new approach withransperitoneal RALP that aims to optimisereservation of the bundles, improvinghe continence and potency rates withoutompromising cancer clearance in a care-ully selected cohort of patients.aterials and Methods: Between July

008 and January 2009 20 patients withrgan confined prostate cancer under-

ent RALP using the new approach. In- S

URO

lusion criteria included a normal baseline-item International Index of Erectileunction score of between 22 to 25 and1c prostate cancer Gleason score � 6nd low volume disease, PSA � 10, with-ut signs of extraprostatic disease on MRI.ostoperatively pathological specimensere assessed for specimen weight, Glea-

on score, tumour volume, pathologicaltage and margin status. The incidencend location of positive surgical marginsere recorded. All patients underwentALP by the same senior surgeon. Theperative technique is described step bytep. Patients were assessed at 1 and 3onths to assess PSA levels, continence

nd potency.esults: Mean age 55 (49-67 range), allere pT1 clinical stage, mean PSA was

.2 (range 3.45-10). Operation time was22 mins (range 105 -186 mins). Averagelood loss was 150mls. On histology,ean prostate size was 38.5 grams (27-54

ange). 50% patients had Gleason 3�3nd 50% were upgraded to 3�4, 90%ere margin clear, both patients with pos-

tive margins were at the apex. At 1onth follow up 90% were totally conti-

ent without any pads. 70% of patientsad achieved early erections with or with-ut cialis at 1 month. At 3 months 80%ad achieved erections and 95% wereontinent and pad free. All patients hadnrecordable PSA levels.onclusion: In a carefully selected co-ort of patients we have shown excellentotency and continence rates at 3 monthsy minimizing neurovascular trauma. Weelieve that this new approach optimiseshe advantages of RALP and can improveost-operative quality of life without com-romising oncological outcome.

ID-05.06ingle-Port Transvesical Enucleationf Prostate (STEP)esai M1, Sotelo R2, Carmona O2, Aron2, Astigueta J2, De Andrade R2, Canes3, Desai M1, Jhoskes D1, Gill I4

The Cleveland Clinic Foundation, Cleve-and, OH, USA; 2Instituto Medico La Flo-esta, Caracas, Venezuela; 3Lahey Clinicedical Center, Burlington, MA, USA;

University of Southern California, Losngeles, CA, USA

ntroduction and Objectives: Weresent the initial series of single portransvesical enucleation of the prostateSTEP) in 22 patients with large volumeenign prostatic hypertrophy.aterials and Methods: Between April

nd September 2008, 22 men underwent

TEP using a transvesical approach under

LOGY 74 (Supplment 4A), October 2009