Vattikuti Institute Prostatectomy: Technical Modifications in 2009

Mani Menon, Alok Shrivastava, Mahendra Bhandari, Ramgopal Satyanarayana, Siddharth Siva, Piyush K. Agarwal

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background: Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients. Objective: To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results. Design, setting, and participants: Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon. Surgical procedure: The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes. Measurements: Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist. Results and limitations: At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%). Conclusion: In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.

Original languageEnglish
Pages (from-to)89-96
Number of pages8
JournalEuropean Urology
Volume56
Issue number1
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Fingerprint

Prostatectomy
Urinary Bladder
Lymph Node Excision
Drainage
Lymph Nodes
Urinary Catheters
Coitus
Reproductive Health
Robotics
Patient Selection
Dissection
Catheters
Equipment and Supplies
Surgeons

Keywords

  • Laparoscopy
  • Prostate cancer
  • Radical prostatectomy
  • Robotic

ASJC Scopus subject areas

  • Urology

Cite this

Vattikuti Institute Prostatectomy : Technical Modifications in 2009. / Menon, Mani; Shrivastava, Alok; Bhandari, Mahendra; Satyanarayana, Ramgopal; Siva, Siddharth; Agarwal, Piyush K.

In: European Urology, Vol. 56, No. 1, 01.07.2009, p. 89-96.

Research output: Contribution to journalArticle

Menon, M, Shrivastava, A, Bhandari, M, Satyanarayana, R, Siva, S & Agarwal, PK 2009, 'Vattikuti Institute Prostatectomy: Technical Modifications in 2009', European Urology, vol. 56, no. 1, pp. 89-96. https://doi.org/10.1016/j.eururo.2009.04.032
Menon, Mani ; Shrivastava, Alok ; Bhandari, Mahendra ; Satyanarayana, Ramgopal ; Siva, Siddharth ; Agarwal, Piyush K. / Vattikuti Institute Prostatectomy : Technical Modifications in 2009. In: European Urology. 2009 ; Vol. 56, No. 1. pp. 89-96.
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