503 Techniques and outcomes of Salvage Robot-assisted Radical prostatectomy- Dr Aditya Parikh

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This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Aditya Parikh, University College London Hospitals.
Abstract:
Techniques and outcomes of Salvage Robot-assisted Radical prostatectomy.
Introduction and objective:
To identify techniques to improve the outcomes of Salvage Robot assisted radical
prostatecctomy
Method:
Salvage radical prostatectomy distinguishes itself from upfront radical prostatectomy
in the primary setting because of tough tissues and difficult planes
In this video, we present tips to adjust the operative technique to the primary
treatment.
External beam radiotherapy or high-dose-rate brachytherapy, the endopelvic
fascia tends to be white. Fibrotic stuck tissue.Very careful posterior dissection is
mandatory to avoid rectal injury. This is illustrated here.
Brachytherapy and cryotherapy: Apical Fibrosis
During DVC and apical dissection, brachytherapy seeds can sometimes be
encountered.
Following hormone treatment, Stuck seminal vesicles : Can take the prostate and
seminal vesicles separately.
In HIFU, the energy is focused near the prostatic midline. To safeguard the rectum,
dissection can be performed from lateral towards midline.
Irregularly shaped prostates with asymmetrical prostate lobes can be seen post-
NanoKnife treatment, TURP, and photodynamic treatment: Care at the bladder
neck. Minimum traction.
Other Stratergies:
Bladder and prostate stitch.
Omental or peritoneal flap
Roberts catheter
PDS delayed absorbable sutures.
Results:
83% Continent at 2 years follow up
Treatment as part of multimodality treatment.(21% BCR, 43%positive margins)
Better outcomes for post Focal therapy treatments than after primary radiotherapy.
8% complications rate
Erectile dysfunction expected
Conclusion:
Salvage radical prostatectomy is feasible and should be performed in experienced
hands and high volume centers for good oncological and functional results with
minimal complications.

See more at: http://vattikutifoundation.com/
Category
Urology
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