ERUS 2019

Mr Christopher Ogden presents to ERUS 2019 his radical perineal insufflated prostatectomy series - the first in Europe and the second series in the world after Dr Jihad Kaouk, Cleveland Clinic, USA.  

Introduction & Objectives
Open perineal prostatectomy (OPP) for decades was a favoured approach for localised prostate cancer surgery. The perineal approach has been largely superseded by the retropubic radical prostatectomy, but OPP still maintains its benefits of avoiding intraperitoneal structures and the abdomen entirely. Urological Professor Jihad Kaouk, Cleveland, USA has pioneered the Robotic Perineal Prostatectomy (RPP) and his expertise shared with our Unit for our first case, has now translated to a series in our Department.
 
Materials & Methods
 Eleven patients were offered RPP with da Vinci surgical system (Intuitive Surgical Inc.) Xi model. Thorough clinic counselling on associated benefits and risks compared to the the traditional retropubic approach was undertaken. Eight patients underwent this procedure and data was retrieved from electronic records.

Results
2/11 patients decided to opt for retropubic prostatecomy. 1/11 patient was advised due to Anaesthetic concerns to have retropubic surgery due to average shorter operative time to completion. 



N = 8 RPP

Age = 64.5 (62 - 70)
ECOG 0/1, ASA 2
BMI 27.3 (23 - 31.5)

Mean Perineal dissection, mean = 40min

Mean Console Time = 125min

Estimated blood loss = 180cc (maximum 300)

Mean Length of stay = 2 days (1 -2)

No post-operative opioid requirements

Conclusions Our UK RPP series is the first in Europe and is safe, feasible and can be taught and assimilated into Units. The peritoneum is not encountered and associated surgical and anaesthetic risks are avoided. Previous major abdominal surgery must no longer exclude patients from Robotic Radical Prostatectomy.