Assisted Laparoscopic Radical Prostatectomy Specimen Removal

Assisted Laparoscopic tooth root prostaticctomy Specimen RemovalRemoving the exemplification with traction during zombieic radical prostaticctomySerkan Altinova, Abidin Egemen Isgoren, Ziya Akbulut, Muhammed Fuat Ozcan, Abdullah Erdem Canda, Ali Fuat Atmaca, Mevalana Derya BalbayKey words Prostate cancer, radical prostate glandctomy, specimen, tractionAbstractPurpose Our aim was to show up if removing the specimen with traction during robot assisted laparoscopic radical prostatectomy cause substantiating working(a) coast or not.Materials and Methods 169 patients with localized prostate cancer who were performed robot assisted laparoscopic radical prostatectomy were included in the poll between 2009-2011. Patients were divided into 2 conferences. Patients characteristics, preop and postop evaluation were recorded.Results on that point were 111 and 58 patints in group 1 (with traction) and group 2 (without traction), respectively. Patients ages, follow up time, body mass in dexes (BMI), prostate spesific antigen (PSA) values, preop and postop Gleason accounting values, pathological stage, positive surgical permissiveness pass judgment and biochemical PSA reccurrence rates were surveyd. There was no statistically significant difference between groups for age, preop PSA values, BMI, preop and postop Gleason scores, positive surgical margin rates and biochemical reccurrence rates. There was significant difference between prostate weight, tumor volume and clinical stage between groups. ( certaintys Removing the specimen with traction during robot assisted laparoscopic radical prostatectomy does not cause positive surgical margin. The incision can be as small as possible for cosmetic sight. foundationRobot-assisted laparoscopic radical prostatectomy (RALP) has become the most preferred surgical technique for localized prostate cancer. One of the most important factor pointing out the oncologic victory is the surgical margin status.(1) Positive surgi cal margin (PSM) status may be related two with the surgeon, surgical technique and disease burden. (1,2 ) Our aim was to evaluate the effect of traction, probably the cause of PSM, during the specimen removal. Ther argon many studies comparing the PSM acording to techniques, pathologic findings and clinical stage but we found none acording the technique of specimen removal. (3)Materials and Methods169 patients who were performed RALP for localized prostate cancer between 2009 and 2011 were included in this study. entirely the patients were evaluated and Ethic Committee permission were given for each. The reason why we planned this study was the patients with postoperative PSM (positive surgical margin) but no PSA (prostate spesific antigen) reccurrence. Patients were randomized as two groups, A and B, acording to their status of traction was done or not man removing the specmen. Traction can be defined as removing the specimen from a small incision that may let the specimen remo ved by traction. No traction can be defined as removing the traction from an incision larger than prostate that make easy removing the specimen without any difficulty.Student-t test was utilise for follow-up, age, BMI (body mass index), PSA, prostate weight and tumor volume. Chi-square test was used for Gleason grade, stage, SMI (surgical margin invasion) and BCR (biochemical reccurrence rates). All the values were calculated as mean and SD. SPSS 16 was used.ResultsGroup A (traction group) had 111 patients while group B (no-traction group) had 58. There was statistically significant difference between groups for prostate weight, tumor volume and clinical stage. Age, BMI, preoperative PSA levels, biopsy Gleason score, prostatectomy Gleason score, pathological stage, SMI status and BCR were similar for both groups. Patients preoperative and postoperative characteristics are summerized in table 1 and 2. Although there are pT0 patients in both groups we have to guess that we have give n no additional therapy like androgen deprivation therapy preoperatively.DiscussionNowadays robot-assisted laparoscopic radical prostatectomy is the main surgical technique for localized prostate cancer. In the United States 85% of radical prostatectomies are performed robotically. (4) Generally PSM rates after different techniques for radical prostatectomy seems to be equal but sometimes surgical technique may effect the rates.(5,6) Oncologic outcomes of robotic performance are generally similar with laparoscopic and open surgery (7-10) although there are some other results suggesting that the rates are different for the techniques. (11-13) The well known object is that the PSM may be related with disease burden, surgeon and also the technique. Robotic surgery has some differences from laparoscopic surgery. The adventages of robotic surgery are related both with the patient and the surgeon. This provides a comfortable operation for the surgeon. In order to find out if traction may cause a PSM, we randomize the patients into two groups as traction or non-traction. We believe that traction may cause a damage on the prostate capsula and show a pseudopositive surgical margin. In our study PSM rates are similar in both groups. Higher tumor volume and stage can effect PSM rates. (2) Although traction group has higher tumor volume rates and lower clinical stage PSM rates are similar. Also prostatectomy Gleason scores are similar for both groups. All the operations were performed by the same person as PSM rates can differ among surgeons performance. Some outhors have described Capsular Incision Index to show the damages on the capsula that may cause pseudopositive surgical margin.(2). We beleive, because of the traction made by the fourth arm of the robot may cause pseudopositive surgical margin, pahologist mustiness reveal that if there is a positive margin coloured with the ink they use, they must also see the capsula of the prostate. If no, this may not be rea lly a positive margin. This is very important as sometimes may affect the extra therapy options. In order not to give any unneccesssary treatment both the surgeon and the pathologist must be very careful as this may not only increase the morbidity but also the cost.ConclusionSurgical margin status after radical prostatectomy is an important topic. Surgical technique is important in order not to cause a positive surgical margin but pathlogical findings are maybe more important for the possible additional treatment. 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