Robotic Prostate - 24th Annual World Congress Of Endourology 2006 - Session MP19

UroToday.com - This session covered a wider range of robot assisted procedures. Procedures such as pyeloplasty, radical prostatectomy, nephroureterectomy, pediatrics, cystectomy, pelvic lymph node dissection, nephrectomy, augmentation cystoplasty, partial nephrectomy and vasovasostomy were presented. Skills training, ergonomics and patient perception data were also discussion.

Presentations of note include what was reported as the first clinical cases of successful robot assisted vasovasostomy. A 34 year old patient had a single layer VV performed with a running 8-0 Prolene suture. A semen analysis at 3 months revealed viable sperm in the semen. Although the operative time was longer than the author's experience with microscopic VV it was felt the OR time would rapidly decrease with experience.

Dr. Haleblian from Duke presented fine work on prospective health-related quality of life assessment for men after robot assisted radical prostatectomy. They presented data revealing that by 6 months 56% of patients had recovered baseline urinary scores, 85.7% recovered bowel scores, and 90.9% had recovery of hormonal domain scores. By 12 months, 20.7% of patients had recovered baseline sexual scores. This number compares very favorably with published open radical prostatectomy data.

Dr. Elhage from the UK presented very interesting work where surgeons were monitored with high definition cameras, motion sensors and EMG electrodes during standardized, repeated in vitro tasks either performed laparoscopically or with robot assistance. They found that due to reduced head and body movement and head support of the robotic platform, surgeons had less strain overall but particularly around the trapezius muscle allow procedures to be performed more easily.

Dr. Fumo working with Dr. Menon reported on their progressive refinement for port placement of robotic trocars for upper tract urinary system surgery. These procedures were performed in rapid succession over a short period of time. They found that rather than the traditional laparoscopic approach with camera placed medially and instruments placed laterally, robotic camera port placement was best facilitated with a lateral position between the anterior axillary line and midclavicular line. The robotic working instruments were then placed 10-11 cm away from the camera to construct a right angle. This approach greatly facilitates camera motion and robotic instrument motion.

By David Lee, MD

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