Abstract
Objective:
In this video, we demonstrate the innovative role of instant toggling of endoscope in key steps of nerve sparing (NS), modified posterior reconstruction, and vesicourethral anastomosis (VUA) in the presence of challenging scenarios during robot-assisted radical prostatectomy using Xi da-Vinci robotic surgical system.
Materials and Methods:
We demonstrate our technique of NS—athermal, early retrograde release, and minimization of tension with identification of landmark artery in an ideal case using 30 down endoscope. Then, the role of instant toggling of endoscope (from 30 down to up) in the Xi da-Vinci robotic surgical system during bilateral complete NS in challenging scenarios of robot-assisted radical prostatectomy (RARP) has also been highlighted. Furthermore, we demonstrated our technique of modified posterior reconstruction and modified von Volthoven VUA in an ideal scenario. Subsequently, we highlighted the role of instant toggling of endoscope (from 30 down to up and vice versa) in the Xi da-Vinci robotic surgical system, in the presence of a challenging scenario of a morbidly obese patient with deep and narrow pelvis, during posterior reconstruction and VUA.
Results:
Twenty patients were included in the study from January 2015 to May 2015. Using the instant toggling of endoscope in the Xi da-Vinci robotic surgical system, the mean time for NS was 12.3 minutes (vs 18.1 minutes in the standard procedure). There were no intraoperative/postoperative complications. The modified posterior reconstruction and VUA could be completed efficiently in all cases.
Conclusions:
The use of instant toggling of endoscope using the Xi da-Vinci robotic surgical system during RARP is feasible and safe. It improves observation of anatomical landmarks and quality of NS. It also facilitates other key steps of modified posterior reconstruction and VUA in a challenging scenario—obese patient, with deep narrow pelvis. The short-term perioperative results are encouraging. However, long-term randomized controlled trials are required to evaluate benefits in functional outcomes over longer period of time and potential negative events.
No competing financial interests exist.
Runtime of video: 6 mins 57 secs
