EXPERIENCE IN PERFORMING LAPAROSCOPIC ROBOT-ASSISTED PROSTATECTOMY IN THE SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

摘要

Aim. To evaluate the immediate (in-hospital) outcomes of laparoscopic robot-assisted prostatectomy in the surgical treatment of large benign prostatic hyperplasia (greater than 80 cm³). Materials and methods. The study presents the immediate (in-hospital) results of simultaneous laparoscopic robot-assisted transperitoneal transvesical prostatectomy in 55 patients with benign prostatic hyperplasia who underwent surgery at the “Innomed – Center for Endosurgery” Medical Center between 2019 and 2024 using the da Vinci S and da Vinci Si surgical systems. Results. To exclude prostate cancer, serum prostate-specific antigen (PSA) testing, MRI, and/or prostate biopsy were performed. Intraoperative blood loss was assessed using the gravimetric method. Post-prostatectomy surgical complications were classified according to the Clavien–Dindo system, and urination was assessed pre- and postoperatively using uroflowmetry. The mean age of the patients was 66.7±4.3 years, mean body mass index – 25.6±3.5 kg/m², mean ASA (American Society of Anesthesiology) score – 1.8±0.2, mean prostate volume – 124.8±25.8 cm³, mean operative time – 219.3±28.7 minutes, mean intraoperative blood loss – 125.7±33.4 ml, and mean postoperative hospital stay – 5.5±1.1 days. Postoperative bleeding occurred in one patient (1.8%) and was managed with electrocautery of the prostate bed vessels. No patients required blood transfusion due to bleeding or blood loss. Complications after laparoscopic robot-assisted prostatectomy occurred in one patient (1.8%) – hyperthermia after urethral catheter removal, which was resolved with antibacterial and anti-inflammatory therapy. Complications according to the Clavien–Dindo classification occurred in 2 patients (3.6%) and were consistent with published data. The mean maximum urinary flow rate (Q max, ml/s) before surgery was 7.9±2.4 ml/s, and after surgery – 25.4±2.9 ml/s (p<0.05). Conclusions. Simultaneous laparoscopic robot-assisted transperitoneal transvesical prostatectomy is characterized by a minimal number of postoperative complications and enables effective restoration of urination in patients with large benign prostatic hyperplasia (greater than 80 cm³).