No 1S (2016)

One of the main tasks of nerve-sparing robot-assisted radical prostatectomy is the maximum preservation of the neurovascular bundle. Due to innovative technology using three-dimensional visualization, «DaVinci» robotic system has the effect of «presence» within the surgical field; and due to multiple zooming, this system allows to perform precise and ultraprecise tissue dissection. A clear differentiation of organs and tissues allows to to reduce the risk of positive surgical margins, and development of urinary incontinence, as well as significantly increase the chance of preserving erectile function postoperatively. Functional and oncologic outcomes of treatment depend on a careful examination of the anatomy of the prostate gland and pelvic organs, knowledge of which is directly connected with the improvement of methods of performing nerve-sparing robot-assisted radical prostatectomy.

The risk of erectile dysfunction (ED) increases with age due to the occurrence of serious opportunistic diseases, particularly hypertension, heart disease, diabetes, and hypogonadism. Detection and treatment of erectile dysfunction and related diseases at an early stage can prevent their progression. As a result, disability of patients can be prevented, we can save their health and performance, and achieve budget savings. In our opinion, currently, most urologists diagnose erectile dysfunction mainly in case of complaints of the patient, without direct survey for the presence of symptoms of ED. In addition, even in case of diagnosis of ED, entire complex of surveys aimed at identifying the accompanying, sometimes very dangerous to the health of patients, diseases is often not carried out. The aim of this study was to find out what methods of diagnosis and treatment of these diseases are used in various medical centers in the Russian Federation, to trace the possible relationships and correlations between the methods of examination and treatment of patients with the above pathology, as well as center and professional experience. According to the results of questioning 783 urologist of 12 centers in Moscow, European Russia, the Urals and Western Siberia, portrait of the typical Russian urologist is made, and information about the methods of examination and treatment of patients with ED, used in various medical centers of Russia are received. Based on these data, we can conclude that further standardization of examination and treatment of patients with ED is required, in order that patients in any region of the Russian Federation could receive high-quality medical care.

In the Urological Clinic of MSMSU n.a. Al Evdokimov based on City Clinical Hospital № 50, a retrospective evaluation of medical records of360patients after radical prostatectomy was conducted. Comparison of preoperative protocols of magnetic resonance imaging (MRI) of pelvic organs with the results of histological examination of surgical specimens was preformed. A calculation of sensitivity, specificity, and overall accuracy of the pelvic MRI in patients with prostate cancer on two separate characteristics was conducted: extracapsular invasion (Ed), and seminal vesicle invasion by the tumor. Pelvic MRI has registered only 19.1 % of cases of histologically confirmed Ed, which proves the low sensitivity of the method in relation to the prognosis of identifying locally advanced prostate cancer. The specificity of MRI in the preoperative diagnosis of Ed was 98.5%. The sensitivity of MRI for the detection of tumor invasion into the seminal vesicles were also low - 30.6%, with specificity of 93.9%. The overall accuracy of the use of MRI in determining the presence of prostate cancer Ed may be recognized as an acceptable - 65%, and for the determination of seminal vesicle invasion can be assessed as high - 85.3%. We believe that the pelvic MRI with contrast enhancement at the stage of preoperative preparation it is advisable to carry out in all patients with prostate cancer.

Significant technological breakthrough and progressive modernization of minimally invasive treatments have led to the fact that the robotic technology occupy a leading position in medicine. Widespread use of robotic surgical systems is caused not only by high technological effectiveness, but also the tendency of transition to organ-sparing surgery. Robotic technology has all benefits of minimally invasive procedures in respect of such parameters as the degree of blood loss, transfusion rate, length of hospital stay, and others; they are far superior to laparoscopic techniques used, and the results of surgical interventions are better than those of open surgery. Thousands of successful robotic operations around the world show a wide introduction of robotic technology in almost all branches of medicine. In this article, we describe our own experience of use of daVinci robotic surgical system.

Ureteral injury - one of the most serious complications of surgery on the pelvic organs and is often associated with a significant risk to the health and lives of patients, ureteral fistula formation and the potential loss of kidney function. There is no any specific medical treatment of iatrogenic ureteral injuries. The localization of injury below the intersection of ureter with the common iliac vessels, and injury of pelvic ureter require the performing ureterocystoneoanastomosis using particular methodology, or plasy of lower ureter using flap formed from the bladder (Boari surgery). In the late XX century, the rapid development of endoscopic techniques made it possible to perform laparoscopic ureterocystoneoanastomosis. From the beginning of the XXI century, the implementation of daVinci robotic system has strengthened the position of endoscopic surgery in reconstructive urology. This observation demonstrates the ability to perform a robotic-assisted ureterocystoneoanastomosis.

Genital prolapse (GP) - a common pathological condition; surgical correction ofGPis one of the most common indications for surgery on the pelvic organs in women. There are many ways of surgical correction of GP, but general recommendations for the surgical treatment of female genital prolapse are still not developed. One of the methods of surgical correction of GP includes sacrocolpopexy. To date, sacrocolpopexy is performed predominantly by a laparoscopic approach and can be used to eliminate virtually any type of GP. Implementation of the procedure by the daVinci robotic system (Intuitive Surgical, Inc., Sunnyvale, CA) using modern synthetic prosthetic and suture materials allows to reduce intervention-induced injury, reduce the risk of postoperative complications and reduce the hospital stay. This clinical observation demonstrates the ability to perform a robotic-assisted sacrocolpopexy.