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Cestari A, Sangalli M, Buffi NM, et al. Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar. J Robot Surg. 2012;7(1):47-51doi: 10.1007/s11701-012-0344-5.
Cestari, A., Sangalli, M., Buffi, N. M., Lazzeri, M., Larcher, A., Scapaticci, E., Lughezzani, G., Fabbri, F., Rigatti, P., & Guazzoni, G. (2013). Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar. Journal of robotic surgery, 7(1), 47-51. https://doi.org/10.1007/s11701-012-0344-5
Cestari, Andrea, et al. "Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar." Journal of robotic surgery vol. 7,1 (2013): 47-51. doi: https://doi.org/10.1007/s11701-012-0344-5
Cestari A, Sangalli M, Buffi NM, Lazzeri M, Larcher A, Scapaticci E, Lughezzani G, Fabbri F, Rigatti P, Guazzoni G. Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar. J Robot Surg. 2013 Mar;7(1):47-51. doi: 10.1007/s11701-012-0344-5. Epub 2012 Mar 08. PMID: 27000892.
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J Robot Surg. 2013 Mar;7(1):47-51. doi: 10.1007/s11701-012-0344-5. Epub 2012 Mar 08.

Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar.

Journal of robotic surgery

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

Affiliations

  1. Minimally Invasive and Robotic Surgery Section, Department of Urology, "Vita-Salute" University San Raffaele Turro Hospital, Via Stamira D'Ancona 20, 20127, Milan, Italy. [email protected].
  2. Minimally Invasive and Robotic Surgery Section, Department of Urology, "Vita-Salute" University San Raffaele Turro Hospital, Via Stamira D'Ancona 20, 20127, Milan, Italy.

PMID: 27000892 DOI: 10.1007/s11701-012-0344-5

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.

Keywords: Bariatric surgery; Obesity; Prostate neoplasm; Robotic prostatectomy; da Vinci prostatectomy

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