Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP)

Initial experience

Khaled Fareed, Osama M. Zaytoun, Riccardo Autorino, Wesley White, Sebastien Crouzet, Rachid Yakoubi, George Pascal Haber, Michael A. White, Jihad H. Kaouk

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Single port transvesical enucleation of the prostate (STEP) performed through a solitary suprapubic incision using a single access port inserted directly into the bladder has been demonstrated to be technically feasible but still challenging.3. Despite being feasible and providing adequate relief of bladder outlet obstruction, robotic STEP carries a high risk of complications. Further evolution of the technique is likely to be strictly dependent on the development of instrumentation. Objective To report our initial experience with a novel robot assisted single port procedure for the management of benign prostatic hyperplasia (BPH). Methods Between March 2009 and July 2010, nine patients with symptomatic BPH were scheduled for robotic single port suprapubic transvesical enucleation of the prostate (R-STEP). Prior to intervention, all were submitted to preoperative transrectal ultrasound of the prostate and uroflowmetry. The surgical procedure included an initial transurethral incision of the prostatic apex. With the patient in the supine position, an approximate 3 cm lower midline incision was made. A cystotomy was created and a GelPort® laparoscopic system positioned in the bladder. The da Vinci S™ robotic operating system was docked through the GelPort® platform and enucleation was performed. Perioperative outcomes and short-term postoperative functional outcomes were assessed. Intra-operative and postoperative complications, graded according to the Dindo-Clavien system, were recorded. Results One patient was excluded from the analysis as the procedure was aborted and converted to open simple prostatectomy. Median operative time was 3.9 h. Median visual analogue pain scale on discharge was 2. Estimated blood loss was 425 mL. Two patients required intra-operative blood transfusion. Postoperatively, two patients developed clot retention and required evacuation and fulguration (grade IIIb), one of them had a deep vein thrombosis (grade II) and a urinary tract infection (grade II). One patient was admitted to the intensive care unit after a myocardial infarction (grade IVa). All patients were discharged after a median of 4.5 days. There was almost three and four times postoperative improvement in both median maximum flow (Qmax) and average flow (Qave) rates, respectively. CONCLUSION The first series of R-STEP is reported herein. Despite being feasible and providing adequate relief of bladder outlet obstruction, the procedure carries a high risk of complications. Further evolution of the technique is likely to be strictly dependent on the development of instrumentation. Thus, its role in the surgical armamentarium of BPH remains to be determined.

Original languageEnglish (US)
Pages (from-to)732-737
Number of pages6
JournalBJU International
Volume110
Issue number5
DOIs
StatePublished - Sep 1 2012

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Robotics
Prostate
Prostatic Hyperplasia
Urinary Bladder Neck Obstruction
Urinary Bladder
Cystotomy
Supine Position
Pain Measurement
Operative Time
Prostatectomy
Urinary Tract Infections
Venous Thrombosis
Blood Transfusion
Intensive Care Units
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP) : Initial experience. / Fareed, Khaled; Zaytoun, Osama M.; Autorino, Riccardo; White, Wesley; Crouzet, Sebastien; Yakoubi, Rachid; Haber, George Pascal; White, Michael A.; Kaouk, Jihad H.

In: BJU International, Vol. 110, No. 5, 01.09.2012, p. 732-737.

Research output: Contribution to journalArticle

Fareed, K, Zaytoun, OM, Autorino, R, White, W, Crouzet, S, Yakoubi, R, Haber, GP, White, MA & Kaouk, JH 2012, 'Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP): Initial experience', BJU International, vol. 110, no. 5, pp. 732-737. https://doi.org/10.1111/j.1464-410X.2012.10954.x
Fareed, Khaled ; Zaytoun, Osama M. ; Autorino, Riccardo ; White, Wesley ; Crouzet, Sebastien ; Yakoubi, Rachid ; Haber, George Pascal ; White, Michael A. ; Kaouk, Jihad H. / Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP) : Initial experience. In: BJU International. 2012 ; Vol. 110, No. 5. pp. 732-737.
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