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A Comparison Between Anterior and Posterior Routes of Seminal Vesicle Dissection During Robotic Prostatectomy: The Posterior Approach May Shorten Operative Times in Glands Larger than 50cc.
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A Comparison Between Anterior and Posterior Routes of Seminal Vesicle Dissection During Robotic Prostatectomy: The Posterior Approach May Shorten Operative Times in Glands Larger than 50cc.
Daniel M. Kaplon, MD, George Haleblian, MD, Gyan Pareek, MD.
The Warren Alpert Medical School of Brown University, 02903, RI, USA.
Background: Studies have demonstrated that operative times are longer during robot assisted laparoscopic radical prostatectomy (RALRP) of large volume prostates (> 50g). Proponents of seminal vesicle dissection by the posterior window (PW) approach have reported that the this approach is efficient for larger volume glands. We compared 100 consecutive procedures at our institution performed by either the anterior window (AW) or PW approach and sought to evaluate any comparable differences between the two approaches during dissection of glands larger than 50 grams.
Methods: The records of 100 consecutive patients undergoing RALRP over a 6 month period (1/07 to 6/07) by either an AW or PW approach were analyzed. Patient age, BMI, PSA, prostate size, operative time, blood loss, and complications were compared between the both cohorts. Student’s t test was used to compare operative time in glands larger than 50cc between the two groups.
Results: 100 patients (n = 33, PW group, and n = 17, AW group) underwent RALRP over a 4 month period. The mean age of the patients was 61 years. The mean BMI was 27 in and the mean pre-op PSA 4.9. Mean prostate volume was 36cc (33 AW and 37 PW, p = .38)). Average operating time was 303 min in the AW group and 277 in the PW group (p=.31). Average blood loss 217cc in the AW group and 126cc in the PW group (p = .06). Mean length of stay was 1.97 days. There was one open conversion in the AW group. There were 3 intraoperative complications (1 AW, 2 PW) and 9 postoperative complications (11% AW, 18% PW). Postoperative complications included GI bleed (1), perirectal hematoma (1), catheter malfunction (2), pulmonary embolism (2), trocar site bleed (1), lymphocele (1), and DVT (1). In glands larger than 50cc, the PW group had shorter operative times, but without significant differences (232 +/- 44 min AW vs 248 +/- 53 min PW).
Conclusions: In a group of patients matched by age, PSA, prostate volume and surgeon experience, the operative parameters are similar for the AW or PW approach during RALRP. For glands larger than 50 grams, the PW window approach may result in a shorter operative time.
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