Robot-assisted partial prostatectomy for anterior prostate cancer: a step-by-step guide

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dc.contributor.authorVillers, Arnauld
dc.contributor.authorFlamand, Vincent
dc.contributor.authorArquímedes, Rodríguez-Carlin
dc.contributor.authorPuech, Philippe
dc.contributor.authorHaber, Georges-Pascal
dc.contributor.authorDesai, Mihir M.
dc.contributor.authorCrouzet, Sebastien
dc.contributor.authorOuzzane, Adil
dc.contributor.authorGill, Inderbir S.
dc.date.accessioned2024-05-24T16:35:39Z
dc.date.available2024-05-24T16:35:39Z
dc.date.issued2017-06
dc.descriptionIndexación: Scopus
dc.description.abstractObjective: To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). Patients and Methods: After Institutional Review Board approval, over an 8-year period (2008–2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low–intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. Results: The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien–Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. Conclusion: PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd
dc.description.urihttps://bjui-journals-onlinelibrary-wiley-com.recursosbiblioteca.unab.cl/doi/10.1111/bju.13785
dc.identifier.citationBJU International Volume 119, Issue 6, Pages 968 - 974June 2017
dc.identifier.doi10.1111/bju.13785
dc.identifier.issn1464-4096
dc.identifier.urihttps://repositorio.unab.cl/handle/ria/57041
dc.language.isoen
dc.publisherBlackwell Publishing Ltd
dc.rights.licenseCC BY 4.0 DEED Atribución 4.0 Internacional
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/deed.es
dc.subject#PCSM
dc.subject#ProstateCancer
dc.subjectfocal therapy
dc.subjectprostate MRI
dc.subjectrobot-assisted surgery
dc.titleRobot-assisted partial prostatectomy for anterior prostate cancer: a step-by-step guide
dc.typeArtículo
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