Easy, reproducible extraperitoneal pelvic access for robot - assisted radical prostatectomy

Antonio Rebello Horta Gorgen, Christian Pavlovich

Research output: Contribution to journalArticle

Abstract

Robot - assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy. We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney - shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10). We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.

Original languageEnglish (US)
Number of pages1
JournalInternational braz j urol : official journal of the Brazilian Society of Urology
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Prostatectomy
Head-Down Tilt
Abdominal Injuries
Learning Curve
Fascia
Robotics
Surgical Instruments
Blood Vessels
Kidney

ASJC Scopus subject areas

  • Urology

Cite this

@article{14c87d1c9a4b48c793e23e347973be50,
title = "Easy, reproducible extraperitoneal pelvic access for robot - assisted radical prostatectomy",
abstract = "Robot - assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy. We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney - shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10). We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10{\%} of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.",
author = "Gorgen, {Antonio Rebello Horta} and Christian Pavlovich",
year = "2019",
month = "1",
day = "1",
doi = "10.1590/S1677-5538.IBJU.2018.0175",
language = "English (US)",
volume = "45",
journal = "International braz j urol : official journal of the Brazilian Society of Urology",
issn = "1677-5538",
publisher = "Brazilian Society of Urology",
number = "1",

}

TY - JOUR

T1 - Easy, reproducible extraperitoneal pelvic access for robot - assisted radical prostatectomy

AU - Gorgen, Antonio Rebello Horta

AU - Pavlovich, Christian

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Robot - assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy. We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney - shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10). We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.

AB - Robot - assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy. We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney - shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10). We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.

UR - http://www.scopus.com/inward/record.url?scp=85062821785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062821785&partnerID=8YFLogxK

U2 - 10.1590/S1677-5538.IBJU.2018.0175

DO - 10.1590/S1677-5538.IBJU.2018.0175

M3 - Article

C2 - 30088726

AN - SCOPUS:85062821785

VL - 45

JO - International braz j urol : official journal of the Brazilian Society of Urology

JF - International braz j urol : official journal of the Brazilian Society of Urology

SN - 1677-5538

IS - 1

ER -