Background:
Since the laparoscopic approach for radical surgical treatment of localized prostate cancer has emerged, an increasing number of specialized centres report good results with this new technique. More recently robot assisted systems have been introduced to facilitate the techniqually very demanding procedure and may allow an even better visualization of the anatomy and a more precise dissection of vital structures. In our video we show a robot assisted extraperitoneal radical prostatectomy as it is performed at our institution with seminal vesicle tip and nerve sparing technique.
Methods:
Since September 2002 we performed 150 robot assisted laparoscopic radical prostatectomies using a daVinci robotic system. We initially adopted the Montsouris techniqueand in the last 74 of 75 procedures we used an extraperitoneal approach. With growing experience slight modifications have constantly been made to ptimize our surgical technique. The seminal vesical tips as well as the neurovascular bundles were spared when PSA was <10 and Gleason-Score was <7.
Results:
Total mean operative Time including installation of the robotic system was 250 minutes and 190 minutes for the last 20 procedures. No procedure had to be converted to open surgery. Our early oncological results are comparable to the results that are known from large series of open radical prostatectomies. However, in regard to blood loss, postoperative pain and hospital stay the endoscopic approach is superior to open surgery.
Conclusions:
As shown in our video, the robot assisted endoscopic extraperitoneal approach allows a very precise anatomical prostatectomy. It offers patiens the benefits of minimal invasive surgery without compromising oncological or functional results.

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