Robotic Urology / Edition 2

by Hubert John, Peter Wiklund

Overview

Robotic surgery is in a phase of worldwide rapid evolution. Data from many centers indicate that urologists are achieving equivalent, or better, operative outcomes using a robotic laparoscopic interface compared with their open results. Patients benefit from quicker convalescence, less pain, and shorter hospital stays. The multi-authored international text covers the robotic operative procedures in urology that are routinely performed today and still in evolution. It focuses on robotic radical prostatectomy and includes robotic procedures for the kidney, adrenal gland, and urinary bladder. The most essential steps are depicted in illustrations. This book should contribute to the support of new robotic teams and continue to popularize robotic urology.

Product Details

ISBN-13:	9783642332142
Publisher:	Springer Berlin Heidelberg
Publication date:	06/19/2013
Edition description:	2nd ed. 2013
Pages:	423
Product dimensions:	7.01(w) x 10.00(h) x 0.04(d)

About the Author

Hubert John Formation in Urology in Winterthur, Zurich, Boston MA and Syracuse NY. Chief of Urology, Kantonsspital Winterthur, Switzerland. Focused in minimal invasive urology and innovative new urological procedures. Several international clinical and basic research awards, as AUA-ACMI-prize 2002, Alken-prize 2001, Munich Innovation prize 2001. Swiss national research foundation and several competitive grants since 10 years. Published over 100 original papers, description of several new operative techniques in radical prostatectomy and urinary incontinence and more than 400 scientific contributions. Editor of the Textbook "Robotic Urology", together with P. Wiklund (Springer, 2008), second edition 2013. First urologic daVinci-procedures in Switzerland 2002. One of the most experienced DaVinci-console surgeons in Europe with over 1000 console surgeon daVinci-procedures including radical prostatectomy, cystectomy, pyeloplasty, partial nephrectomy and many live, andguest proctorships abroad.

Table of Contents

History of Robotic Surgery in Urology   Andras Hoznek
Introduction     1
Background     1
Endourology     2
Transurethral Prostate Resection     2
Ablatherm     2
Prostate Biopsy     2
Percutaneous Renal Access     3
Laparoscopic Surgery     3
Robotic Camera Holders     3
Master-Slave Systems     4
Clinical Experience with Master-Slave Systems in Urological Laparoscopy     5
Radical Prostatectomy     6
Radical Cystectomy and Urinary Diversion     6
Pyeloplasty     6
Live Donor Nephrectomy     7
Future of Robotic Surgery     7
Surgical Anatomy of the Prostate for Radical Prostatectomy   Arnauld Villers   Thierry Piechaud
Introduction     11
Pelvic Fasciae, Parietal and Visceral, and Their Surgical Importance     11
Parietal Fasciae     12
Visceral Fasciae     12
Fascial Surgical Dissection     14
Nerve-sparing Technique     15
Proximal Bladder Neck Sphincter and Detrusor Apron     16
Urethral Stump (Sphincteric Urethra) Preservation     16
Prostatic Capsule     16
Rectourethralis     17
Robotic Radical Prostatectomy: Extraperitoneal Approach   Hubert John
Introduction     19
Extraperitoneal Approach: Step by Step     19
Discussion     23
Patient Positioning     23
Trocar Placement     24
Operative Time     24
Avoiding the Intraperitoneal Cavity     25
Conclusion     26
Robotic Radical Prostatectomy: Transperitoneal Access   Charles-Henry Rochat   Jean Sauvain
Introduction     29
Steps of the Transperitoneal Access     30
Preparation     30
Installation of the Patient     31
Access to the Pelvis and Incision of the Anterior Peritoneum     31
Pelvic Lymphadenectomy for Localized Prostate Cancer and Robotic-assisted Radical Prostatectomy   Oliver W. Hakenberg   Manfred P. Wirth
Arguments for and Against Routine Pelvic Lymphadenectomy     37
Morbidity of Pelvic Lymphadenectomy     37
Extent of Pelvic Lymphadenectomy     38
Location of Node-positive Disease and Lymphatic Drainage     39
Purpose of Lymphadenectomy     40
Influence of Lymphadenectomy on Outcome in RP     41
The Likelihood of Nodal Disease Based on the Use of Nomograms     42
PLND or no PLND?     43
Pelvic Lymphadenectomy in Conventional Laparoscopic and Robot-assisted Radical Prostatectomy     44
Use of PLND in Robot-assisted Radical Prostatectomy     44
Technique of PLND in Robotic Radical Prostatectomy     45
Conclusion     47
Bladder Neck Dissection During Robotic-assisted Laparoscopic Radical Prostatectomy   Thierry Piechaud   Filippo Annino
Introduction     51
Anatomy of the Bladder Neck     51
Anatomical-Surgical Correlations     52
Median Lobe     52
Previous TURP     53
Functional and Oncological Principles of Bladder Neck Preservation     53
Surgical Technique of Bladder Neck-sparing Dissection During Robotic-assisted Prostatectomy     54
Median Lobe     59
Previous TURP     60
Wide Resection of the Bladder Neck     61
Indications and Choice of Technique     61
Bordeaux Series     61
Conclusion     62
Nerve-sparing Techniques for Laparoscopic and Robot-assisted Radical Prostatectomy   Ketul K. Shah   Mario F. Chammas Jr.   Kenneth J. Palmer   Rahul Thaly   Vipul R. Patel
Introduction      65
Neurovascular Anatomy     65
Neurovascular Bundles     66
Nerve-sparing Techniques and Results     66
Athermal Approaches to Nerve Sparing     67
Seminal Vesicle Tip Preservation to Improve Potency     67
Categorization of Approaches to Nerve-sparing Robotic Prostatectomy     67
Nerve Sparing in Robotic-assisted Laparoscopic Prostatectomy     68
The Henry Ford Technique: the Veil of Aphrodite     68
The Ohio State Technique: Athermal Early Retrograde NVB Release During Antegrade Prostatectomy     69
UC Irvine: Antegrade Clamp and Suture Technique     72
University of Chicago: Antegrade Thermal Clipless Approach     73
Nerve Sparing in Laparoscopic Radical Prostatectomy     74
Cleveland Clinic: Clamp-and-Suture Technique with Ultrasound Guidance     74
Heilbronn Technique     75
Discussion     75
Conclusion     76
Vattikuti Institute Prostatectomy: Veil of Aphrodite Nerve-sparing Technique   Alok Shrivastava   James O. Peabody   Mani Menon
Introduction     81
Indications and Patient Selection     82
Setup     82
Operating Room     82
The Surgical Team      83
Instruments     83
Robotic Instruments     83
Laparoscopic Instruments     83
Sutures     83
Technique of VIP     84
Specific Patient Preparation     84
Patient Positioning and Port Placement     85
Development of the Extraperitoneal Space     85
Lymph Node Dissection     86
Bladder Neck Transection     86
Nerve-sparing Technique: the "Veil of Aphrodite"     93
Exposure of Prostatic Apex and Control of Dorsal Venous Complex     96
Urethrovesical Anastomosis     96
Retrieval of Specimen and Completion of Surgery     99
Postoperative Care     99
Crossing Over the Learning Curve     99
Structured Program     100
Setup     100
Patient Selection     100
Robotic Assisted Radical Prostatectomy: the Apical Dissection   Xavier Cathelineau   Jamison Jaffe   Eric Barret   Francois Rozet   Guy Vallancien
Introduction     103
Preparation of the Apex     103
Dorsal Venous Complex     106
Completion of the Neurovascular Bundles     107
Urethral Transection and Division of the Rectourethralis      107
Vesicourethral Anastomosis   Jean Joseph
Introduction     109
Semicontinuous Suturing     109
Continuous Suturing     111
Interrupted Suturing     112
Complications     113
Intraoperative     113
Postoperative     114
Conclusion     116
Outcome Measures After Robot-assisted Laparoscopic Prostatectomy   Esequiel Rodriguez   Douglas W. Skarecky   Thomas E. Ahlering
Introduction     117
Operative Results     118
Operative Time     118
Blood Loss and Transfusions     118
Peri-operative Complications     126
Convalescence     126
Oncological Control     127
Surgical Margins and PSA Recurrence     127
Quality of Life     129
Continence     129
Potency     130
Conclusion     132
Urinary Incontinence After Robotic-assisted Laparoscopic Radical Prostatectomy   Kevin G. Chan   Timothy G. Wilson
Introduction     137
Incidence of Urinary Incontinence Following Radical Prostatectomy     137
Mechanism of Urinary Incontinence Following Radical Prostatectomy      139
Risk Factors for Urinary Incontinence Following Radical Prostatectomy     140
Evaluation for Urinary Incontinence Following Radical Prostatectomy     141
Management of Urinary Incontinence Following Radical Prostatectomy     142
Detrusor Overactivity     142
Urethrovesical Anastamotic Strictures     142
Post-prostatectomy Stress Urinary Incontinence     143
Behavioral Therapy     143
Medical Therapy     144
Transurethral Injection Therapy     144
Male Slings     145
Artificial Urinary Sphincter     146
Conclusion     148
Erectile Function After Robotic Prostatectomy: Anatomical Aspects and Treatment   Juan I. Martinez-Salamanca   Ashutosh Tewari
Introduction     153
Incidence     153
Pathophysiology     154
Anatomical Foundations About Nerve-sparing Surgery     155
Tri-zonal Concept for the Nerve-sparing Robotic Prostatectomy     155
Proximal Neurovascular Plate     156
Predominant Neurovascular Bundles     157
Accessory Distal Neural Pathways     158
The Distribution and Functional Classification of the Autonomic Ganglion Cells     159
Distribution      159
The Functional Classification     161
Robotic Surgical Techniques (Modifications) to Preserve Sexual Function     161
Athermal Robotic Technique (Cornell University)     161
Bladder Neck Transection     161
Seminal Vesicle and Vas Dissection     162
Incision of Denonvillier's Fascia and Posterior Dissection to the Apex     162
Lateral Pedicle Control     162
Release of Neurovascular Bundles     162
Apical Dissection, DVP Ligation and Urethral Transection     164
"Veil of Aphrodite" Nerve Sparing     164
"Cautery-Free" Neurovascular Bundle Preservation     165
"Modified Clipless Antegrade Nerve Preservation"     165
Robotic Series: Sexual Outcomes     166
Weill Medical College (Cornell University) Experience     166
Erectile Dysfunction After Radical Prostatectomy: Treatment Strategies     167
Evaluation     167
Questionnaire-based Assessment     167
Clinical Assessment of Patient with ED After Radical Prostatectomy     168
Nocturnal Penile Tumescence Testing     168
Duplex Doppler Assessment     168
Dynamic Infusion Cavernosometry and Cavernosography     169
Treatment      169
Phosphodiesterase-5 inhibitors     169
Sildenafil     169
Vardenafil     170
Tadalafil     170
Intracavernosal Injections     170
Vacuum Constriction Devices     171
Combination Therapy     172
Treatment Protocol for the Patient with ED After RP     172
Robotic Pyeloplasty   L. Henning Olsen   Yazan F. Rahwashdeh
Introduction     177
The Retroperitoneal Approach     178
Patient Preparation and Positioning     178
Retroperitoneal Access and Port Placement     179
Docking of the Surgical Cart and Placement of Instruments     180
The Procedure     180
The Transperitoneal Approach     182
Patient Preparation and Positioning     182
Transperitoneal Access and Port Placement     183
Docking of the Surgical Cart and Placement of Instruments     183
The Procedure     183
Follow-up     184
Surgical Outcome     184
Operative Time     184
Success Rates     186
Complications     186
Conclusion     186
Robot-assisted Radical Cystectomy   Khurshid A. Guru    Martin N. Jonsson   Peter Wiklund
Introduction     189
Patient Selection     190
Preoperative Preparation     190
Equipment     190
Port Placement     191
Identification and Dissection of Ureters     192
Male Cystectomy     192
Posterior Dissection     192
Lateral Dissection of the Bladder     192
Nerve-sparing Dissection     193
Apical Dissection     194
Female Cystectomy     194
Technique Where Four Robotic Arms Are Used     194
Control and Positioning of Uterus     194
Control of Vascular Pedicle     194
Vaginal Dissection     195
Mobilization of Bladder and Dissection of Urethra     195
Reconstruction of the Vaginal Wall     196
Pelvic Lymph Node Dissection     196
Robot-assisted Urinary Diversion     198
Robot-assisted Ileal Conduit Intracorporeal Technique     198
Robot-assisted Orthotopic Neobladder, Intracorporeal Technique     198
Discussion     200
Robotic Kidney Surgery   Jorn H. Witt
Introduction     203
Patient Evaluation and Preparation     203
General Considerations for Robotic Kidney Surgery     204
Surgical Approaches     205
Transperitoneal Approach     206
Patient Positioning and Port Placement     206
Left-side Kidney Preparation     207
Dissection and Securing of the Renal Hilum     208
Right-side Kidney Preparation     209
Retroperitoneal Approach     209
Patient Positioning and Port Placement     209
Kidney Preparation     210
Nephrectomy     210
Simple Nephrectomy     210
Donor Nephrectomy     211
Radical Nephrectomy     212
Nephron-sparing Procedures     212
Nephroureterectomy     214
Other Procedures     215
Postoperative Management     216
Complications and Management     216
Future Perspectives     217
Robotic Adrenal Surgery   Elias Hyams   Michael D. Stifelman
Introduction     223
Indications     224
Operative Technique     226
Right Robotic Adrenalectomy     226
Left Adrenalectomy     228
Results     232
Considerations     235
Conclusion      236
Robotic Antireflux Surgery in Children   Piet Callewaert
Introduction     239
Conventional Laparoscopic Techniques in the Treatment of VUR     240
Robotically Assisted Techniques     241
General Considerations     241
Intravesical Technique     241
Overview     241
Detailed Description of Technique     241
Patient Positioning     241
Port Placement     242
Sequence of Surgical Steps     242
Port-site Closure     243
Postoperative Management     244
Results and First Impressions     245
Extravesical Technique     246
Overview     246
Detailed Description of Technique     246
Patient Positioning     246
Port Placement     246
Sequence of Surgical Steps     247
Postoperative Management     248
Results and First Impressions     248
Discussion and Conclusion     249
Economic Aspects of Starting a Da Vinci Robotic Surgery Program   Roland Peplinski   Ryan Rhodes
Introduction     253
Description of the Technology     253
Hospital Resources: Broad Economic Impact      254
Market Share Growth and Maximizing Efficiency     254
Clinical Validation     256
Urology Procedures     256
Cardiothoracic Procedures     256
Gynecological Procedures     257
General/Pediatric Surgery Procedures     257
Universal Patient Benefits     258
Business Model     258
Market Analysis     259
Cost Analysis     259
Subject Index     263

Editorial Reviews

Reviewer: Costas D. Lallas, MD, FACS (Thomas Jefferson University)
Description: In the third edition of this comprehensive book, recognized experts in the field describe in detail virtually all commonly performed robotic urologic procedures; more complex and/or controversial procedures are not included.
Purpose: The purpose is to have the experts describe the step-by-step procedures on which they have built their careers. This is a high-level how-to book compiled by thought leaders in the field.
Audience: This will serve as a reference for individuals familiar with robotic surgery. It is not intended for novices, but instead for those who can decipher the different nuances of a particular procedure in order to consider incorporating it into their practice.
Features: The 50 chapters are divided into nine parts, each of which covers a general common topic or organ system. Part 1 presents general information regarding robotic surgery, such as available robotic surgical systems, and anesthetic, credentialing, and training considerations. Parts 2 through 8 are divided by organ systems, and part 9 discusses the various surgical complications surrounding robotic urologic surgery and how they can be managed or avoided. Each chapter that describes a surgery covers set-up, positioning, instrumentation, port placement, and a detailed description of both personal and more generalized surgical techniques. With its focus on common procedures, omitting more advanced or controversial surgeries, the book is relatable for a larger audience.
Assessment: This will be an excellent addition to the library of those seeking to hone their experience with common robotic urologic procedures. It is accompanied by additional online materials, which are a big plus for books that describe surgical techniques.

Doody's Review Service

In the third edition of this comprehensive book, recognized experts in the field describe in detail virtually all commonly performed robotic urologic procedures … . This will be an excellent addition to the library of those seeking to hone their experience with common robotic urologic procedures.” (Costas D. Lallas, Doody's Book Reviews, July, 2018)

From the Publisher