Robotic Assisted Prostatectomy with Magnetic Retraction

Abstract

Introduction: In prostate surgery retraction of the prostate is essential to ensure appropriate visualization of the surgical field. In the past improvement in exposure would require the dedicated use of a port or an additional incision. Magnetic retraction provides a novel solution by allowing shaftless retraction during robotic assisted prostatectomy that does not require a dedicated port or extra incision.

Methods: We conducted a retrospective review of consecutive patients who underwent robotic assisted prostatectomy using magnetic retraction at a single center (Duke Regional Hospital) between April 2017 and November 2018.

Results: The 39 cases were all robotic assisted total prostatectomies for adenocarcinoma. All cases were successfully completed without conversion to open. Mean age was 63 years (range 44-75) and preoperative body mass index was 30.4 kg/m² (range 20.1-43.9). Mean operative time was 184 minutes (range 129-304). Four patients experienced minor 30-day complications that were not directly attributed to the device and did not require further interventions. One patient suffered a myocardial infarction 5 days after surgery and recovered without major sequelae. There were no 30-day mortalities. Surgeons described subjective overall surgical exposure as adequate and device use as technically simple.

Conclusions: Magnetic assisted retraction is a novel approach that allows a safe and reproducible technique for unconstrained tissue retraction, and manipulation does not require another port. The device successfully permitted optimal prostate retraction during robotic assisted prostate surgery, enhancing surgical exposure while not requiring additional abdominal incisions.

Keywords: magnetics; minimally invasive surgical procedures; prostatectomy; robotic surgical procedures.