A new method for posterior pelvic reconstruction with autologous tissue in robot-assisted radical prostatectomy

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Abstract

BACKGROUND: Despite the improvement of surgical techniques and a significant improvement in the functional results of surgical interventions for prostate cancer urinary incontinence after radical prostatectomy remains the most important factor that negatively affects the quality of life of patients.

AIM: Evaluation of the effectiveness and safety of a new technique for posterior reconstruction using autologous tissue an endopelvic fascia flap in robot-assisted radical prostatectomy.

MATERIALS AND METHODS: 28 patients with localized prostate cancer who underwent modified robot-assisted radical prostatectomy at one medical center were included in the study. During the operation after removal of the prostate a posterior reconstruction of the small pelvis was performed by excising a flap of the endopelvic fascia on one side, placing it behind the bladder neck and urethrocystoanastomosis, followed by fixing this flap to a similar structure on the opposite side in the form of a loop, strengthening the anastomosis from behind. The main intraoperative parameters, oncological and functional results were evaluated.

RESULTS: Analysis of the results of the study confirmed the high efficiency of the proposed surgical technique. The average operation duration was 145 min (120–170 min), average console time was 68 min (55–102 min), the average duration of the posterior reconstruction stage was 6 min (3.5–8.5 min). Average intraoperative blood loss was 55 ml (25–175 ml). The urethral catheter was removed on the 7th day after the operation in all patients. During surgery there were no conversions and any complications of III–V groups according to the Clavien – Dindo classification. Immediate urinary continence was noted in 23 (82.1%) patients (82,1%), early urinary continence was noted in 26 (92.8%) patients.

CONCLUSIONS: The results of the study showed that the use of a new technique for posterior reconstruction in robot-assisted radical prostatectomy using endopelvic fascia flaps is effective and safe, showing good early functional results, in particular, immediate urinary continence without compromising oncological outcomes.

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About the authors

Mkrtich S. Mosoyan

Almazov National Medical Research Centre; Academician I.P. Pavlov First St. Petersburg State Medical University

Email: moso03@yandex.ru
ORCID iD: 0000-0003-3639-6863
SPIN-code: 5716-9089
Scopus Author ID: 57208982777

Dr. Sci. (Med), Head of the Department of Urology with the Course of Robotic Surgery and the Clinic, Head of the Center for Robotic Surgery, Professor of the Department of Urology

Russian Federation, 2, Akkuratova St., Saint Petersburg, 191014; 6-8, Saint-Petersburg

Denis A. Shelipanov

Almazov National Medical Research Centre

Email: shelipanov_da@almazovcentre.ru

Сand. Sci. (Med.), Head of Urology Division

Russian Federation, 2, Akkuratova St., Saint Petersburg, 191014

Dmitriy A. Fedorov

Almazov National Medical Research Centre

Email: tvoiurolog@gmail.com
ORCID iD: 0000-0002-6371-4620

Assistant of the Department of Urology with the Course of Robotic Surgery and the Clinic

Russian Federation, 2, Akkuratova St., Saint Petersburg, 191014

Nadezhda A. Aysina

Almazov National Medical Research Centre

Email: aysina1984@mail.ru
SPIN-code: 3168-2228

Assistant of the Department of Urology with the Course of Robotic Surgery and the Clinic

Russian Federation, 2, Akkuratova St., Saint Petersburg, 191014

Artem A. Vasil'ev

Almazov National Medical Research Centre

Author for correspondence.
Email: scapoflow@gmail.com

Assistant of the Department of Urology with the Course of Robotic Surgery and the Clinic

Russian Federation, 2, Akkuratova St., Saint Petersburg, 191014

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2. Fig. 1. Reconstruction of the main stages of the operation. а – The prostate bed. The prostate gland has been removed. 1 – urethra, 2 – bladder neck, 3 – intrapelvic fascia. The dotted line on both sides marks the line of resection of the intrapelvic fascia, from which the flap will be formed; b – urethrocystoanastomosis (1), flaps from the intrapelvic fascia are formed on both sides (2); c – a flap of the intrapelvic fascia (2) was passed under the urethrocystoanastomosis (1), fixed to a similar flap of the intrapelvic fascia on the opposite side in the form of a loop reinforcing the urethrocystoanastomosis from behind

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3. Fig. 2. Sewing of the formed flap from the intrapelvic fascia on the right with absorbable suture material

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4. Fig. 3. A flap of the intrapelvic fascia was placed under urethrocystostomosis, the flap was fixed to a similar structure from the opposite side in the form of a loop

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