Assisted Laparoscopic Radical Prostatectomy Specimen Removal

help Laparoscopic Radical Prostatectomy Specimen RemovalRemoving the ideal with traction during zombiic thorough prostatic glandctomySerkan Altinova, Abidin Egemen Isgoren, Ziya Akbulut, Muhammed Fuat Ozcan, Abdullah Erdem Canda, Ali Fuat Atmaca, Mevalana Derya Balbay place words Prostate genus Cancer, radical prostatectomy, type, tractionAbstractPurpose Our puzzle was to show if removing the specimen with traction during robot assisted laparoscopic radical prostatectomy deliver supportive operative leeway or not.Materials and Methods 169 patients with localized prostate crabmeat who were performed robot assisted laparoscopic radical prostatectomy were included in the study in the midst of 2009-2011. Patients were divided into 2 collections. Patients characteristics, preop and postop evaluation were recorded.Results There were 111 and 58 patints in group 1 (with traction) and group 2 (with out(p) traction), respectively. Patients ages, follow up time, body surge indexes (BMI), prostate spesific antigen (PSA) values, preop and postop Gleason score values, pathological form, positive surgical margin pass judgment and biochemical PSA reccurrence range were evaluated. There was no statistically of import difference between groups for age, preop PSA values, BMI, preop and postop Gleason scores, positive surgical margin range and biochemical reccurrence rates. There was significant difference between prostate weight, tumour leger and clinical stage between groups. (Conclusions Removing the specimen with traction during robot assisted laparoscopic radical prostatectomy does not possess positive surgical margin. The scratch line can be as slight as possible for cosmetic sight.IntroductionRobot-assisted laparoscopic radical prostatectomy (RALP) has become the most preferred surgical proficiency for localized prostate cancer. One of the most important factor pointing out the oncologic success is the surgical margin status.(1) autocratic surgica l margin (PSM) status whitethorn be related both with the surgeon, surgical proficiency and disease burden. (1,2 ) Our aim was to evaluate the effect of traction, probably the cause of PSM, during the specimen removal. Ther argon m any(prenominal) studies comparing the PSM acording to techniques, pathologic findings and clinical stage besides we found none acording the technique of specimen removal. (3)Materials and Methods169 patients who were performed RALP for localized prostate cancer between 2009 and 2011 were included in this study. All the patients were evaluated and Ethic Committee licence were given for each. The reason why we planned this study was the patients with postoperative PSM (positive surgical margin) scarcely no PSA (prostate spesific antigen) reccurrence. Patients were randomized as two groups, A and B, acording to their status of traction was done or not while removing the specmen. grip can be defined as removing the specimen from a small mother fucker tha t may let the specimen removed by traction. No traction can be defined as removing the traction from an incision larger than prostate that make easy removing the specimen without any difficulty.Student-t footrace was utilise for follow-up, age, BMI (body mass index), PSA, prostate weight and tumor volume. Chi-squ ar test was used for Gleason grade, stage, SMI (surgical margin invasion) and BCR (biochemical reccurrence rates). All the values were calculated as mean and SD. SPSS 16 was used.ResultsGroup A (traction group) had 111 patients while group B (no-traction group) had 58. There was statistically significant difference between groups for prostate weight, tumor volume and clinical stage. Age, BMI, operative PSA levels, biopsy Gleason score, prostatectomy Gleason score, pathological stage, SMI status and BCR were comparable for both groups. Patients preoperative and postoperative characteristics are summerized in table 1 and 2. Although there are pT0 patients in both groups we have to say that we have given no additional therapy like androgen deprivation therapy preoperatively.DiscussionNowadays robot-assisted laparoscopic radical prostatectomy is the main surgical technique for localized prostate cancer. In the get together States 85% of radical prostatectomies are performed robotically. (4) Generally PSM rates after various techniques for radical prostatectomy seems to be equal but sometimes surgical technique may effect the rates.(5,6) Oncologic outcomes of robotic surgery are generally similar with laparoscopic and discourteous surgery (7-10) although there are some other results suggesting that the rates are different for the techniques. (11-13) The well known object is that the PSM may be related with disease burden, surgeon and also the technique. Robotic surgery has some differences from laparoscopic surgery. The adventages of robotic surgery are related both with the patient and the surgeon. This provides a comfortable operating room for the surgeon. In do to find out if traction may cause a PSM, we randomised the patients into two groups as traction or non-traction. We reckon that traction may cause a damage on the prostate capsula and show a pseudopositive surgical margin. In our study PSM rates are similar in both groups. Higher tumor volume and stage can effect PSM rates. (2) Although traction group has higher tumor volume rates and lower clinical stage PSM rates are similar. alike prostatectomy Gleason scores are similar for both groups. All the operations were performed by the same person as PSM rates can differ among surgeons performance. around outhors have described Capsular Incision Index to show the restitution on the capsula that may cause pseudopositive surgical margin.(2). We beleive, because of the traction made by the fourth arm of the robot may cause pseudopositive surgical margin, pahologist mustiness reveal that if there is a positive margin coloured with the sign they use, they must also see the capsula of the prostate. If no, this may not be real a positive margin. This is genuinely important as sometimes may affect the extra therapy options. In order not to give any unneccesssary treatment both the surgeon and the pathologist must be very careful as this may not only increase the unwholesomeness but also the cost.ConclusionSurgical margin status after radical prostatectomy is an important topic. Surgical technique is important in order not to cause a positive surgical margin but pathlogical findings are maybe more important for the possible additional treatment. Removing the specimen with traction during robot assisted laparoscopic radical prostatectomy does not cause positive surgical margin. The incision can be as small as possible for cosmetic sight.ReferencesWiezer AZ, Strope S, Wood DP. Margin control in robotic and laparoscopic prostatectomy What are the REAL oucomes. Urol Oncol. 2010 28210-14.Hong H, Mel L, Taylor J, Wu Q, Reeves H. Effects of robotic-as sisted laparoscopic prostatectomy on surgical pathology specimens. Diagn Pathol. 2012 724-30.Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer A systematic check out and meta-analysis comparing retropubic, laparoscopic and robotic prostatectomy. Eur Urol. 2012 621-15.Lowrance WT, Parekh DJ. The fast uptake of robotic prostatectomy and its collateral effects. Cancer. 2012 11847.Philippou P, Waine E, Rowe E. Robot-assisted laparoscopic prostatectomy versus open comparison of the learning thin of a single surgeon. J Endourol. 2012 261002-08.Coelho RF, Rocco B, Patel MB, et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy a criticai review of outcomes reported by high volume centers. J Endourol. 2010 242003-15.Parsons JK, Bennett JL. Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology. 2008 724 1216.Ficarra V, Novara G, Fracalanza S, et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 10453439.Schroeck FR, Sun L, Freedland SJ, et al. Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy. BJU Int. 2008 1022832.Laurila TA, Huang W, Jarrard DF. Robotic-assisted laparoscopic and radical retropubic prostatectomy induce similar positive margin rates in low and average risk patients. Urol Oncol. 2009 2752933.Williams SB, Chen MH, DAmico AV, et al. Radical retropubic prostatectomy and robotic-assisted laparoscopic prostatectomy likelihood of positive surgical margin(s) Urology. 2010 7610971101.Cathcart P, Murphy DG, Moon D, Costello AJ, Frydenberg M. Perioperative, functional and oncological outcomes after open and minimally invasive p rostate cancer surgery experience from Australasia. BJU Int. 2011 107(Suppl 3)1119.Magheli A, Gonzalgo ML, Su LM, et al . Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy an analysis using propensity score matching. BJU Int. 2011 107195662. put back 1. Preoperative characteristics of patientsTable 2. Patients postoperative findings1