Surgical Technique, and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure
This video was one of the videos entered in the 2022 KS International Robotic Surgery Innovation Awards. Produced by a former Vattikuti Fellow at the VUI, Dr. Akshay Sood, it features outstanding graphics and has a clear, step-by-step explanation of the procedure.
Description of Surgical Technique, and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure (IDEAL Stage 1-2b Study)
1Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 2VCORE – Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI 3Department of Pathology, Henry Ford Hospital, Detroit, MI 4Urology Associates and UPMC Western Maryland, Cumberland, MD 5Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 6Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
Background: The existing treatment options for men with intermediate or high-volume low risk prostate cancer (PCa) are associated with a substantial risk of over- or undertreatment. There is an unmet need for developing risk-adjusted therapies for these patients.
Methods: We describe our novel technique of precision prostatectomy, a form of surgical focal therapy that allows for radical excision of the index PCa lesion along with greater than 90% prostatic tissue extirpation while preserving the prostatic capsule and seminal vesicle/vas deferens complex on the side contralateral to the dominant cancer lesion, and to report on medium-term functional and oncologic outcomes in the first 88 consecutive men who underwent this procedure between December 2016 and January 2020. Inclusion/Exclusion criterial are listed in the video.
Results: At study-entry, the median (IQR) age, PSA, and SHIM score were 60.0 (54.2- 65.9) years, 5.7 (4.2-7.1) ng/mL, and 22 (19-24), respectively. The median (IQR) follow- up was 25 (14-38) months. At 12-months, all (100%) patients were continent (0-1 pads), with 90.9% of patients using 0 pads. Eighty-five percent of all-comers and 90.2% of the preoperatively potent men were potent at 12-months. From an oncological standpoint, at 36-months, a 93.4% of patients were free from clinically-significant residual PCa, and 91.7% had not undergone any additional treatment. All patients were alive and free of metastatic disease at 36-months.
Conclusions: Precision prostatectomy is technically safe, reproducible, and offers excellent postoperative functional results. At 36-months of follow-up, the oncologic outcomes and secondary treatment rates appear to be superior to existing ablative focal therapy results.
Narrated robotic surgery video, with animated graphics, PPT’s, 07:52
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