Robotic laparoscopic radical prostatectomy: Setup and procedural techniques after 150 cases

ObjectivesTo report our current methods of patient positioning, establishing the pneumoperitoneum, port placement, and helpful maneuvers during the procedure that have been refined over the course of our initial experience with robotic laparoscopic radical prostatectomy (RLRP). RLRP is gaining popularity as a minimally invasive technique for treating patients with organ-confined prostate cancer. Because this is a new procedure, strategies to optimize the surgical technique are constantly evolving.MethodsTwo genitourinary surgeons experienced in open surgery with no laparoscopic experience began performing RLRP in December 2003 after appropriate training and mentoring. During the course of the ensuing 150 cases, new techniques were developed in an attempt to simplify the operation and improve its outcome.ResultsWe documented and illustrated techniques for patient positioning, safe and rapid placement of the initial camera trocar, use of the third working arm of the da Vinci Surgical System, trocar positioning, and prostatic retraction to assist with posterior dissection.ConclusionsWe have described setup techniques and principles we developed during our experience with the da Vinci robotic system. These points of technique may be helpful for simplifying a procedure that is still in evolution.