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Review
. 2021 Jan;8(1):81-88.
doi: 10.1016/j.ajur.2020.10.002. Epub 2020 Oct 23.

Robotic surgery techniques to approach benign prostatic hyperplasia disease: A comprehensive literature review and the state of art

Marcio Covas Moschovas  1   2 , Frederico Timóteo  2 , Leonardo Lins  2 , Oséas de Castro Neves  2 , Kulthe Ramesh Seetharam Bhat  1 , Vipul R Patel  1
Affiliations
Review

Robotic surgery techniques to approach benign prostatic hyperplasia disease: A comprehensive literature review and the state of art

Marcio Covas Moschovas et al. Asian J Urol. 2021 Jan.

Abstract

Abstract: Objective: The robotic-assisted approach to simple prostatectomy (RASP) was conceived, essentially reproducing the fundaments of open simple prostatectomy. Since the first report, RASP underwent several technical modifications. The study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia (BPH).

Methods: The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020, assessing robot-assisted surgical techniques for BPH treatment using the terms "robot-assisted simple prostatectomy" OR "robotic simple prostatectomy" OR "RASP" AND "surgical technique".

Results: After careful review of 180 studies in PubMed and 198 in Embase, 16 papers reporting different RASP techniques. After the first procedure described by Sotelo et al. [9], several authors contributed to the development of the RASP technique. John et al. [24] proposed the extraperitoneal access, and Yuh et al. [23] first reported the adenoma transcapsular dissection. Some modifications were proposed by Coelho et al. [31] on trigonization, posterior reconstruction, and urethro-vesical anastomosis. Other groups focused on urethral-preserving procedures. Moschovas et al. [28] and Clavijo et al. [32] recently described an intrafascial RASP with the removal of the entire prostatic tissue. Finally, Kaouk et al. [29] reported the feasibility and safety of the da Vinci Single Port approach.

Conclusion: In the last eighteen years, the robotic-assisted approach to BPH disease has been evolved, and different techniques have been described. This review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.

Keywords: Benign prostatic hyperplasia; Minimally invasive; Robotic-assisted; Simple prostatectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evidence synthesis.
Figure 2
Figure 2
Magnetic resonance imaging. Figs. 2A and 2B illustrate a 550 g prostate 60 days after arterial embolization; Figs. 2C and 2D illustrate prostates with big median lobes.
Figure 3
Figure 3
Intraoperative aspect of a big prostate (550 g) after arterial embolization. (A) Right prostate side and bladder wall; (B) Left prostate side and bladder wall.
Figure 4
Figure 4
Intraoperative view of a prostate with big median lobe.
See this image and copyright information in PMC

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