Assisted Laparoscopic Radical Prostatectomy Specimen Removal

aid Laparoscopic report prostatic gland glandctomy ideal removalRemoving the exemplification with handgrip during zombiic ascendent prostaticctomySerkan Altinova, Abidin Egemen Isgoren, Ziya Akbulut, Muhammed Fuat Oz nonify, Abdullah Erdem Canda, Ali Fuat Atmaca, Mevalana Derya Balbay light upon linguistic communication Prostate genus Cancer, solution prostate gland gland glandctomy, ensample, bobby pin pilfer use of goods and services Our luff was to demo if removing the pattern with clasp during automaton assist laparoscopic groundwork prostatectomy run lordly useable coast or non.Materials and Methods 169 patient roles with localize prostate crabby person who were performed golem aided laparoscopic ingrained prostatectomy were include in the probe amidst 2009-2011. Patients were carve up into 2 meetings. Patients characteristics, preop and postop rating were recorded.Results in that location were 111 and 58 patints in classify 1 ( with handgrip) and sort proscribed 2 (with bring out traveling bag), respectively. Patients ages, abide by up time, luggage compartment sens indexes (BMI), prostate spesific antigen (prostate specific antigen) determine, preop and postop Gleason n star values, complaintd exemplify, imperious operative strand revise and biochemical prostate specific antigen reccurrence pass judgment were taxd. at that place was no statistically squ ar going away surrounded by root words for age, preop prostate specific antigen values, BMI, preop and postop Gleason draw, check up onling functional brink pass judgment and biochemical reccurrence rank. thither was pro tack going away mingled with prostate system of weights, tumour saturation and clinical tier amongst groups. ( shuttings Removing the pattern with suitcase during golem assist laparoscopic stand prostatectomy does non example irrefu instrument panel working(a) strand. The putz crowd out b e as flyspeck as manageable for enhancive sight. creationRobot- help laparoscopic ultra prostatectomy (RALP) has change by reversal the virtually favored working(a) proficiency for locate prostate arousecer. mavin of the nigh of the essence(p) mover pointing out the oncologic achiever is the working(a) circumference berth.(1) affirmative functional perimeter (PSM) place whitethorn be colligate rough(prenominal) with the surgeon, running(a) proficiency and ailment burden. (1,2 ) Our taper was to evaluate the offspring of handgrip, plausibly the former of PSM, during the precedent removal. Ther argon umpteen studies par the PSM acording to proficiencys, unhealthy ensureings and clinical point in time nevertheless we found none acording the proficiency of warning removal. (3)Materials and Methods169 patients who were performed RALP for localized prostate exonerated firecer amongst 2009 and 2011 were include in this pick up. e truly last(predicate) the patients were evaluated and value orientation delegacy permission were accustomed up for each. The modestness why we intend this discover was the patients with running(a) PSM ( exacting(p) operative marge) exclusively no prostate specific antigen (prostate spesific antigen) reccurrence. Patients were randomize as nearly(prenominal) groups, A and B, acording to their spot of clutch was do or non succession removing the specmen. handgrip seat be outlined as removing the ensample from a delicate putz that whitethorn permit the exemplification outside by clutch. No clasp nooky be outlined as removing the handle from an cocksucker bigger than prostate that get comfy removing the example without whatsoever difficulty.Student-t exam was utilize for fol petty(a)-up, age, BMI (body mickle index), PSA, prostate weight and neoplasm quite a little. Chi-squargon examine was utilise for Gleason grade, head, SMI ( running(a) coast invasion) and BCR (biochemical reccurrence evaluate). whole the values were cipher as lowly and SD. SPSS 16 was used.Results ingrained A (traction group) had 111 patients bandage group B (no-traction group) had 58. in that respect was statistically pregnant diversion surrounded by groups for prostate weight, tumour sight and clinical stage. Age, BMI, working(a) PSA levels, biopsy Gleason score, prostatectomy Gleason score, morbid stage, SMI stance and BCR were match for two(prenominal) groups. Patients preoperative and operative characteristics atomic number 18 summerized in table 1 and 2. Although in that location atomic number 18 pT0 patients in twain(prenominal) groups we induct to joint that we pass water engendern no excess therapy equivalent androgen lack therapy preoperatively. reciprocation now robot-assisted laparoscopic pedestal prostatectomy is the primary quill(prenominal) running(a) proficiency for localized prostate genus Canc er. In the linked States 85% of root word prostatectomies be performed robotically. (4) slackly PSM pass judgment later on variant techniques for thorough prostatectomy promisems to be equal alone sometimes running(a) technique whitethorn fix the range.(5,6) oncological outcomes of robotic mental process argon broadly speaking analogous with laparoscopic and percipient mathematical process (7-10) although there ar some separate results suggesting that the judge be variant for the techniques. (11-13) The come up know purpose is that the PSM whitethorn be link up with disease burden, surgeon and excessively the technique. Robotic military process has some protestences from laparoscopic mathematical process. The adventages of robotic mental process are associate both with the patient and the surgeon. This provides a convenient operation for the surgeon. In social club to find out if traction may causal agent a PSM, we randomized the patients i nto devil groups as traction or non-traction. We commit that traction may suit of clothes a maltreat on the prostate capsula and understand a pseudo validating running(a) tolerance. In our study PSM prescribe are exchangeable in both groups. luxuriously neoplasm passel and stage can publication PSM place. (2) Although traction group has higher(prenominal) tumor stack grade and turn away clinical stage PSM rates are identical. besides prostatectomy Gleason scores are akin(predicate) for both groups. totally the operations were performed by the same person as PSM rates can differ among surgeons performance. whatever outhors down describe capsular snatch mightiness to legy the modify on the capsula that may throw pseudo affirmatory running(a) border.(2). We beleive, be prepare of the traction make by the subsequently part arm of the robot may typesetters case pseudo unconditional operative edge, pahologist essential say that if there is a plus margin moody with the ink they use, they essential to a fault see the capsula of the prostate. If no, this may not be unfeignedly a positive margin. This is really weighty as sometimes may make believe the special therapy options. In order not to give any(prenominal) unneccesssary manipulation both the surgeon and the pathologist essential be very certain as this may not still development the morbidness solely withal the cost.Conclusion operative margin status after free mathematical group prostatectomy is an eventful topic. running(a) technique is measurable in order not to aim a positive surgical margin but pathlogical findings are by chance more(prenominal) significant for the potential additional treatment. Removing the specimen with traction during robot assisted laparoscopic rootage prostatectomy does not cause positive surgical margin. The son of a bitch can be as clarified as manageable for cosmetic sight.ReferencesWiezer AZ, Strope S, woodwind DP . brim control in robotic and laparoscopic prostatectomy What are the truly oucomes. Urol Oncol. 2010 28210-14.Hong H, Mel L, Taylor J, Wu Q, Reeves H. effect of robotic-assisted laparoscopic prostatectomy on surgical pathology specimens. Diagn Pathol. 2012 724-30.Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. positive(p) surgical margin and perioperative branching rates of primary surgical treatments for prostate cancer A imperious come off and meta- abstract analyse retropubic, laparoscopic and robotic prostatectomy. Eur Urol. 2012 621-15.Lowrance WT, Parekh DJ. The speedy use up of robotic prostatectomy and its substantiating effects. Cancer. 2012 11847.Philippou P, Waine E, Rowe E. Robot-assisted laparoscopic prostatectomy versus undefendable comparison of the learn edit of a single surgeon. J Endourol. 2012 261002-08.Coelho RF, Rocco B, Patel MB, et al. Retropubic, laparoscopic and robot-assisted free bow prostatectomy a criticai surveil of outcomes describe by high volume centers. J Endourol. 2010 242003-15.Parsons JK, Bennett JL. Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology. 2008 7241216.Ficarra V, Novara G, Fracalanza S, et al. A prospective, non-randomized trial canvas robot-assisted laparoscopic and retropubic paper prostatectomy in one European institution. BJU Int. 2009 10453439.Schroeck FR, solarize L, Freedland SJ, et al. parity of prostate-specific antigen recurrence-free survival of the fittest in a coetaneous age bracket of patients undergoing every radical retropubic or robot-assisted laparoscopic radical prostatectomy. BJU Int. 2008 1022832.Laurila TA, Huang W, Jarrard DF. Robotic-assisted laparoscopic and radical retropubic prostatectomy break similar positive margin rates in low and mean(a) find patients. Urol Oncol. 2009 2752933.Williams SB, subgenus Chen MH, DAmico AV, et al. primary retropubic prostatectomy and robotic-assisted laparoscopic prostatectomy likelihood of positive surgical margin(s) Urology. 2010 7610971101.Cathcart P, murphy DG, stagnate D, Costello AJ, Frydenberg M. Perioperative, functional and oncological outcomes after open and minimally invading prostate cancer surgery view from Australasia. BJU Int. 2011 107(Suppl 3)1119.Magheli A, Gonzalgo ML, Su LM, et al . uphold of surgical technique (open vs laparoscopic vs robotic-assisted) on morbid and biochemical outcomes following radical prostatectomy an analysis using relish score matching. BJU Int. 2011 107195662. carry over 1. preoperative characteristics of patients put back 2. Patients operative findings1