Robotic assisted radical prostatectomy in morbidly obese patients

How to create a cost-effective adequate optical trocar

Andrea Cestari, Mattia Sangalli, Nicolò Maria Buffi, Massimo Lazzeri, Alessandro Larcher, Emanuele Scapaticci, Giovanni Lughezzani, Fabio Fabbri, Patrizio Rigatti, Giorgio Guazzoni

Research output: Contribution to journalArticle

Abstract

Obesity is a major health issue in modern society, and with the progressive widespread employment of robotic assisted radical prostatectomy (RALP), the urologist-robotic surgeon is increasingly involved in the treatment of obese patients. However, the vast majority of urological departments are not equipped with a complete set of bariatric instruments. One of the potential difficulties of robotic surgery on the morbidly obese patient is the relatively short length of the optical trocar sheath, as the optical robotic arm requires some very valuable centimeters of the sheath to hang onto. This condition may make it impossible to properly reach the peritoneal cavity with the optical trocar during the RALP procedure. We present a series of four morbidly obese patients (BMI ranging from 42. 1 to 46. 2) with localized prostate cancer treated with RALP. We have developed an effective and "easy-to-implement" solution to the problem of properly elongating the sheath of the optical trocar which involves the use of the plastic cylindrical transparent protective tube of a disposable 26-Ch Amplatz sheath. The Amplatz sheath, with an internal diameter of 13 mm and length of 25 cm, perfectly fits outside of the 13-mm trocar usually employed for the optical trocar. Additionally, the cylindrical tube perfectly fits and hangs onto the robotic optical arm system. Mean operative time was 202. 5 min (range 185-220 min). Mean blood loss was 284 mL (range 185-380 mL). Catheterization time and hospital stay were 5 and 6 days, respectively, in all patients. All procedures were safely completed, and no minor or major complications were reported. The optical trocar lengthening technique allowed us to properly perform RALP procedures even in severely morbidly obese patients in an urological setting not equipped for bariatric minimally invasive surgery.

Original languageEnglish
Pages (from-to)47-51
Number of pages5
JournalJournal of Robotic Surgery
Volume7
Issue number1
DOIs
Publication statusPublished - 2013

Fingerprint

Robotics
Prostatectomy
Surgical Instruments
Costs and Cost Analysis
Bariatrics
Optical Devices
Minimally Invasive Surgical Procedures
Peritoneal Cavity
Operative Time
Catheterization
Plastics
Length of Stay
Prostatic Neoplasms
Arm
Obesity
Health

Keywords

  • Bariatric surgery
  • da Vinci prostatectomy
  • Obesity
  • Prostate neoplasm
  • Robotic prostatectomy

ASJC Scopus subject areas

  • Surgery
  • Health Informatics

Cite this

Robotic assisted radical prostatectomy in morbidly obese patients : How to create a cost-effective adequate optical trocar. / Cestari, Andrea; Sangalli, Mattia; Buffi, Nicolò Maria; Lazzeri, Massimo; Larcher, Alessandro; Scapaticci, Emanuele; Lughezzani, Giovanni; Fabbri, Fabio; Rigatti, Patrizio; Guazzoni, Giorgio.

In: Journal of Robotic Surgery, Vol. 7, No. 1, 2013, p. 47-51.

Research output: Contribution to journalArticle

Cestari, Andrea ; Sangalli, Mattia ; Buffi, Nicolò Maria ; Lazzeri, Massimo ; Larcher, Alessandro ; Scapaticci, Emanuele ; Lughezzani, Giovanni ; Fabbri, Fabio ; Rigatti, Patrizio ; Guazzoni, Giorgio. / Robotic assisted radical prostatectomy in morbidly obese patients : How to create a cost-effective adequate optical trocar. In: Journal of Robotic Surgery. 2013 ; Vol. 7, No. 1. pp. 47-51.
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