Robotic Perineal Radical Prostatectomy is performed with a small incision of 3-4 cm from the region between the anus and the testicles using robot technology. This technique, which is applied only in the Medical Clinic of the Bahçelievler Hospital in our country, is referred to the medical literature as “BakırköyTuğcu Technique”.
The prostate is located at the base of the pelvic space in the body in other words in the most difficult area to reach. In order to reach the prostate from the incision made to the abdominal skin, it is necessary to go further below the location of the bladder. In classical robotic surgery, the connection between the bladder and the abdominal wall is cut and normal anatomy is changed to reach the prostate. Approximately 25 cm distance should be covered to reach the prostate from the skin. In Robotic Perineal Radical Prostatectomy method, this distance is reduced to 5 cm since the perineal entry is made. In this method, the connection between the bladder and the abdominal wall ,the structure holding all the internal organs, which is called endopelvic fascia, are not cut, in other words the normal anatomical structure is not changed.
In Robotic Perineal Radical Prostatectomy method, the muscles passing through the prostate and the nerves that provide penile erection, the vessels feeding the prostate and the large vessels in the abdomen are protected better.The reason for better preservation of these nerves is that the prostate does not move much during the operation.
In classical robotic
surgery performed with perforated
holes from the abdomen, the main veins (dorsal vein complex) feeding the
prostate are sutured
to prevent bleeding.However, in the perineal radical prostatectomy , this suturing process is
not required.
Furthermore, in the classical robotic surgery, there is a risk of damaging the
large vessels in the abdominal wall and abdomen during the placement of arms of
the robot. However, this risk is not found in the robotic radical perineal
prostatectomy method.
“Robotic Perineal Radical Prostatectomy” ,which is referred to the world medical literature as “BakırköyTuğcu Technique”, is a preferred method especially for patients who have undergone abdominal surgery previously.
Perineal Radical Prostatectomy can also be performed by open surgery.However, open surgery is difficult if the prostate is larger than 60 gr, and in cases where the lymph nodes need to be removed, a separate incision should be made from the abdomen.Robotic Perineal Radical Prostatectomy has eliminated these disadvantages of the open method.
In this method, removal of lymph nodes with tumor involvement is possibleand can be successfully performed in prostates larger than 60 g. With this technique, the removal of lymph nodes have been performed for the first time in the world with “BakırköyTuğcu Technique” by Prof. Dr. VolkanTuğcu and has the largest series in the world about prostatectomy with Robotic Perineal Radical Prostatectomy.
In which patient groups does the robotic perineal prostatectomy method apply?
Patients who have undergone surgery for colon cancer
Patients who have undergone surgery previously for colon cancer have serious anatomic abnormalities and abdominal adhesions due to abdominal operations.This situation makes almost impossible to perform abdominal surgical procedures again.Such patients are well-suited for the Robotic Perineal Prostatectomy performed by entering the region between the rectum and the testicles.
Patients with kidney transplantation
It is difficult to reach the prostate by entering into the abdomen in patients who have undergone renal transplantation before.These patients are also suitable for robotic perineal radical prostatectomy. In classical robotic surgery to be performed from the abdomen, there is a possibility that the transplanted kidney may be damaged due to the change in the anatomy of the urinary tract and bladder.
Patients with artificial bladder
The Robotic Perineal Radical Prostatectomy method is a comfortable method
for patients who have undergone bladder removal surgery before due to the bladder cancer and who has artificial bladder from the intestine.
In classical robotic surgery, there is a risk of damage to the artificial bladderbecause the bladder structure is intervened to reach the prostate at the entrance of the abdomen.
This risk is eliminated in the Perineal Radical Prostatectomy.
Patients receiving radiation therapy to their abdomen
Patients who have previously received radiation therapy in the abdominal region are not eligible for classical robotic surgery. This is because structural changes adhesions and deterioration of abdominal organs and tissues occur due to radiation therapy. Prostate cancer is also successfully treated in these patients by robotic surgery from the perineal region.
Patients with Penile Implants
Some types of penile implants are made with abdominal implanted devices, so abdominal surgical intervention is generally not preferred. Prostate cancer surgery in patients with penile implant can be performed safely from the perineal region.
The comfort and privileges of the robotic perineal radical prostatectomy method are as follows;
There is no abdominal pain in the postoperative period because no action is performed in the abdomen that contains the intestines.
Generally, there are no difficulties such as gas extraction and bowel movements.
The patient is discharged on average a few days after surgery and can continue his daily life a week later.
Since the operation is performed in a small incision in the area between the anus and testicles, the scar does not appear after a while.
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