Nörovasküler Bundle Koruyucu Robot Yardımlı Radikal Prostatektomide Klipsiz ve Atermal Pedikül Kontrolü Sağlayan Selektif Sütürasyon Tekniği

Clipless and Athermal Pedicle Control with Selective Suturing Technique Proceeding with Neurovascular Bundle Preservation during Robot Assisted Radical Prostatectomy

Özet

Amaç: Robot yardımlı radikal prostatektomi operasyonu sırasında pedikül kontrolü; cerrahi klipler ve/veya farklı

Abstract

Aim: During robot assisted radical prostatectomy, pedicle control can be accomplished by surgical clips and/or usingdifferent energy sources. Migration of surgical clips can cause bladder neck contracture and bladder stone formation.On the other hand;using different energy sources during pedicle division may cause thermal injury of the nerves which are critical forrecovery of potency. In order to obviate this situation; we describe clipless and athermal pedicle control with selectivesuturing technique proceeding with neurovascular bundle preservation during robot assisted radical prostatectomy.Matherials and Methods: Robot assisted radical prostatectomy (RARP) is performed via transperitoneal route inantegrade fashion. After bladder neck incision, prostatic pedicle is divided. First right prostatic pedicle is selectivelyfreed and cut. Bleeding is controlled by a running V-Loc suture. Then neurovascular bundle is gently separated fromthe prostatic capsule starting at the basis and proceeding towards the apex. The same procedure is performed forthe left prostatic pedicle. Following prostatectomy superficial bleeders are meticulously controlled by separate 5-0polyfilament sutures. Between March 2018 and May 2019 this technique was performed in 29 patients. Bilateral nervesparing procedure was carried out in all cases.Result: Mean preoperative PSA was 8.1±2.1 ng/ml, mean patient age was 60.8±6.5 and mean follow-up was 13.6±9.9months. Mean console time, intraoperative blood loss and prostatectomy specimen weight were 201±45 min,237±97 ml. and 59±29 gr., respectively. Complications were assessed according to the Clavien-Dindo classification.Clavien Grade 2, 3a and 3b complications were encountered in 1, 2 and 1 patients, respectively. Surgical margins werepositive in 5 patients (17.2%). At post-operative first month 28 of 29 patients were continent. Potency rate was 66%with PDE5 inhibitors.Conclusion: Clipless control of pedicles during RARP(Robot assisted radical prostatectomy) seems to be feasiblewithout compromising intraoperative blood loss.