Athermal robotic technique of prostatectomy in patients with large prostate glands (>75 g):: technique and initial results

OBJECTIVE To report our experience with robotic radical prostatectomy (rRP) for prostate glands of > 75 g, as this technique is developing rapidly. PATIENTS AND METHODS Between January 2005 and November 2005, 30 men with prostates of > 75 g had rRP. Their clinicopathological and operative data were reviewed. Technical considerations for successful rRP in patients with large glands are discussed, including the importance of surgical exposure and multiple traction sutures. RESULTS The mean (range) specimen weight was 116.1 (75.3-346.0) g, the patient age 65.0 (56-72) years, the body mass index 28.4 (21-41) kg/m(2), the preoperative International Prostate Symptom Score 10 (0-32), and the prostate-specific antigen (PSA) level 7.54 (1.9-20.1) ng/mL. The clinical stage was T1c in 26 men and T2a in four. The biopsy Gleason scores were 3 + 3 = 6 in 25 men, 3 + 4 = 7 in four and 4 + 3 = 7 in one. The mean (range) estimated blood loss was 208 (100-600) mL and the operative duration 193 (150-270) min. The cancer was organ-confined in all patients and all surgical margins were negative. The mean (range) duration of indwelling catheterization was 12.7 (11-14) days. There were no complications during or after rRP, and the PSA level was undetectable in all patients after surgery. CONCLUSIONS RP for patients with large prostates is technically challenging. The robotic approach does not appear to compromise oncological control. We show the feasibility of rRP for men with large glands.