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

98 Scopus citations

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

Keywords

  • Laparoscopy
  • Prostate cancer
  • Radical prostatectomy
  • Robotic

ASJC Scopus subject areas

  • Urology

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