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

Abstract. Introduction. Laparoscopic robot-assisted prostatectomy for benign prostatic hyperplasia (BPH) was introduced into urological practice in 2008 as a minimally invasive alternative to open, traumatic prostatectomies associated with a high rate of postoperative complications. The aim – to evaluate the immediate (in-hospital) outcomes of laparoscopic robot-assisted prostatectomy in the surgical treatment of large-volume benign prostatic hyperplasia (greater than 80 cm³). Materials and Methods. This study presents the immediate (in-hospital) outcomes of single-session laparoscopic robot-assisted transperitoneal transvesical prostatectomy in 55 patients with benign prostatic hyperplasia who underwent surgery at the “Innomed – Endosurgery Center” Medical Center between 2019 and 2024 using da Vinci S and da Vinci Si surgical systems. Prostate cancer was ruled out using serum prostate-specific antigen (PSA) testing, MRI, and/ or prostate biopsy. Intraoperative blood loss was measured using the gravimetric method. Surgeries were performed via a transperitoneal transvesical approach: in 25 patients, access was through the dome (superior wall covered by peritoneum) of the urinary bladder, and in 30 patients through the anterior wall after peritoneal incision in the area of the median umbilical fold with entry into the Retzius space. Postoperative complications were classified using the Clavien–Dindo system, and urinary function was evaluated before and after surgery using uroflowmetry. The mean patient age was (66.7 ± 4.3) years, mean body mass index – (25.6 ± 3.5) kg/m3, mean ASA (American Society of Anesthesiology) score – (1.8 ± 0.2), and mean prostate volume – (124.8 ± 25.8) cm³. Results. The mean operative time was (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 controlled by electrocoagulation of the prostatic bed vessels after the patient was returned to the operating room. No patient required blood transfusion due to bleeding or blood loss. Postoperative complications occurred in 1 patient (1.8%) – fever following urethral catheter removal, which was resolved with antibacterial and anti-inflammatory therapy. Clavien–Dindo complications were observed in 2 patients (3.6%) and corresponded to data reported in the literature. The mean maximum urinary flow rate (Qmax, ml/s) on uroflowmetry before surgery was (7.9 ± 2.4) ml/s, and after surgery – (25.4 ± 2.9) ml/s (p < 0.05). Conclusions. Single-session laparoscopic robot-assisted transperitoneal transvesical prostatectomy is associated with a minimal number of postoperative complications and allows effective restoration of urination in patients with large-volume benign prostatic hyperplasia (over 80 cm3).