Robotic Assisted Laparoscopic Pelvic Surgery in Patients with pre-existing Prosthetic Reservoir

Robotic Assisted Laparoscopic Pelvic Surgery in Patients with pre-existing Prosthetic Reservoir
Harish Talla MD, Naveen Kella MD, Urology San Antonio, San Antonio, TX
Robotic surgery is minimally invasive surgery, which has opened newer horizons of pelvic surgeries. It is widely accepted among surgeons that they often have to operate upon patients with prior pelvic surgeries, and such cases may become challenging when a foreign object is encountered. Establishing the usual landmarks becomes difficult and harm to the foreign object could occur. In this video we are suggesting a few key steps to manage the reservoir in a patient with a pre-existing inflatable penile prosthesis. Safe dissection minimizes risk of  an infection or malfunction due to violation of  the neocapsule surrounding the reservoir. The key points of the suggested technique are decompressing the bladder using a small Foley catheter and deflating the reservoir causing artificial erection prior to the start of surgery. Doing dissection away from the reservoir helps establish anatomical landmarks, which helps with orientation when dissecting around the reservoir. Towards the end of procedure, the reservoir is reinflated to confirm its integrity and reduce the artificial erection.

Hospital Stay Beyond Two Nights for Robotic Assisted Laparoscopic Prostatectomy

The following abstract was accepted for presentation at the International Robotic Urology Society meeting in Las Vegas for 2010.

Hospital Stay Beyond Two Nights for Robotic Assisted Laparoscopic Prostatectomy
Kusuma Kurmayagari MD, Naveen Kella MD
San Antonio, TX

In experienced hands, robotic assisted laparoscopic prostatectomy generally results in quick discharge home. Reasons for hospital stay beyond 2 days are examined from electronic hospital data from a single-surgeon series of 707 consecutive cases from April 2007 to September 2009 at a community-based institution. The surgeon had performed over 700 cases previously within a different system. A transperitoneal technique using the Montsouris approach was used. Criteria for discharge include pain control on oral medication, ability to ambulate and tolerate a regular diet and to be medically stable. Drains were removed prior to discharge in the vast majority, except in cases of increased drainage after a lymph node dissection. No open conversions were performed. 72% of patients were discharged after one night in the hospital. 21% were discharged after two nights in the hospital. The most common diagnosis for stay beyond two nights was ileus in 10 of the 34 patients (1.4%). The second most common reason was nonmedical in 7 of 34 patients. Post operative anemia requiring blood transfusion occurred in 4 patients (0.5%). Heavy drainage due to a urinoma was noted in one patient who was discharged drain free after 4 nights. The longest hospitalization was for 28 days due to unrecognized bowel perforation during adhesolysis. This was the only patient requiring a return to the operating room. No thromboembolic events or deaths were noted. Robotic prostatectomy can be a procedure with acceptable complication rates during the post-operative period, making the procedure suitable for an community-based practice.

Book Chapter on Robotic Prostatectomy

Open publication