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Rev Mex Urol. 2018 November-December;78(6):476-77 DOI: https://doi.org/10.24245/revmexurol.v78i6.2223
Víctor Osvaldo Mendoza García,1 Juan Carlos Orozco Lara,2 Christian Isaac Villeda Sandoval3
1 Urology Residency, Department of Urology, Centro Médico Nacional, Hospital de Especialidades de Puebla, IMSS.
2 Urology Service Administration
3 Department of Urology
Centro Médico Naval, Secretaría de Marina, Mexico City.
To the best of our knowledge, the currently documented experience in Mexico of robotic-assisted radical prostatectomy does not include descriptions of the procedure utilizing the da Vinci® Xi™ Surgical System. Therefore, we report herein on the experience with the first patient to be operated on in Mexico with said system.
It is known that prostate cancer is the second most frequent cancer in males (31.6 cases per 100,000 men) and the fifth cause of cancer death (7.8 deaths per 100,000 men) worldwide.1 In Mexico it is the first cause of cancer-related morbidity and mortality in men between the ages of 50-74 years.2 Robotic-assisted radical prostatectomy is a treatment option in patients with intermediate-risk prostate cancer.
Since approval of the da Vinci® Si™ system for laparoscopic robotic-assisted surgery, important advances have been made in robotic surgery, such as the capacity to measure and report results, risks, and complications. Several authors of systematic reviews have reported improvement in surgical margins, urinary continence, and erectile function in patients undergoing robotic-assisted radical prostatectomy.3-6
In 2014, the da Vinci® Xi™ Surgical System was approved in the United States, consequently extending its utilization across the globe. Simpler docking, the possibility of placing the laparoscopy lens in any arm, autofocus, and an arm design enabling them to be placed closer to each other, are some of its more important advantages.
The patient operated on was a 71-year-old man, with a past history of transurethral resection of the prostate and diagnosis of acinar adenocarcinoma of the prostate made through transrectal biopsy of the prostate, with a Gleason score of 6 (3+3), preoperative prostate specific antigen level of 10.5 ng/mL, nonsuspicious digital rectal examination, and intermediate-risk disease classification. He underwent robotic-assisted radical prostatectomy through the transperitoneal approach and bilateral nerve-sparing technique (Figures 1 and 2). The result of the histopathologic report was acinar adenocarcinoma of the prostate, a Gleason score of 7 (3+4), tumor in 30% of the sections evaluated, disease affecting both lobes, no extraprostatic extension or seminal vesicle invasion, and negative surgical margins.
The patient had favorable postoperative progression and the transurethral catheter was removed on postoperative day 8. Two days later, he had complete urinary continence. The patient presented with right orchiepididymitis at day 15 and received antibiotic therapy. He reported adequate erections for sexual intercourse at postoperative week 10, under treatment with 5 mg per day of Cialis.
The patient’s perioperative progression was considered acceptable and the oncologic results promising. The case presented herein validates the use of the da Vinci®Xi™ Surgical System at the Hospital Naval de Alta Especialidad, motivating us to conduct a cohort study utilizing that technology.
1. IARC/WHO. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence Worldwide in 2012 [en línea], Dirección URL: <http://globocan.iarc.fr/Pages/fact_sheets_population.aspx>. [Consulta: enero 2017].
2. Torres-Sánchez LE, et al. Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013. Salud Pub Mex 2016;58(2).
3. Coelho RF, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 2010;24(12):2003-15. DOI: 10.1089/end.2010.0295
4. Porpiglia F, et al. Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol 2013;63(4):606-14. DOI: 10.1016/j.eururo.2012.07.007.
5. Porpiglia F, et al. Five-year outcomes for a prospective randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol Focus 2018;4(1):80-86. DOI: 10.1016/j.euf.2016.11.007.
Figure 1. Medical team during the first surgery performed with the da Vinci® Xi™ Surgical System in Mexico.
Figure 2. Resected surgical specimen.
Víctor Osvaldo Mendoza García