There are many forms of therapy for BPH (benign prostatic hyperplasia). Prostates that are very large respond poorly long term to minimally invasive therapies. Robotic simple prostatectomy is the newest therapy for large prostates.
BPH involves growth of the middle part of the prostate. The treatment involves removal of this part called the adenoma.
I performed my first robotic simple prostatectomy this past week using the da Vinci surgical system, from Intuitive surgical. I performed the procedure in a retropubic fashion similarly to the open procedure with some robotic modifications that I made from my experience with the cancer operation, da Vinci prostatectomy. The procedure took about 2 1/2 hours and the patient went to the regular surgical floor without bladder irrigation. The blood loss and pain were very similar. The patient developed a small amount of constipation that kept him in the hospital for 2 days, but a 24 hour stay should be adequate in general.
The important point from this is that this robotic approach was far superior to the open version that has a high blood loss and a 3-7 day hospital stay. I feel it is also much easier than the laparoscopic approach which will never be implemented in a widespread fashion.
The largest series of the laparoscopic, non robotic series I found was from a multicenter study including Dr. Gill.
Their key findings were:
RESULTS: Mean operative time was 156 minutes (range 85 to 380), blood loss was 516 ml (range 100 to 2,500), hospital stay was 48 hours (range 15 to 110), and Foley catheter duration was 6.3 days (range 3 to 7). Mean specimen weight on pathological examination was 72 gm (range 32 to 120). Five patients (29%) required blood transfusion.
My first patient had a TRUS volume of 82 cc, lost about 50 ccs of blood, and went home at 42 hours. I have not performed any laparoscopic simple prostatectomies, but I have performed about 30-35 open ones. My first robotic one went as well as could be expected. I think my robotic experience of over 100 cases, along with my open experience, and experience with HOLEP (Laser enucleation of the prostate) all contributed to our success.
I think this can be easily replicated by a surgeon with moderate robotic experience and familiarity with the open approach.
The only prior experience I know of with robotic simple prostatetcomies was from Dr. Kawachi, at the City of Hope hospital in California. I discussed his approach prior to my first case and he pointed out that he opens the endopelvic fascia prior to opening the capsule. I found this approach beneficial as well and will be writing a paper on my approach.