First experience of performing laparoscopic robot-assisted prostatectomy in surgical treatment of large benign prostatic hyperplasia (more than 80 cm³)

Annotation. The study aimed to evaluate the immediate (in-hospital) outcomes of laparoscopic robot-assisted prostatectomy in the surgical treatment of large benign prostatic hyperplasia (BPH) exceeding 80 cm³. Immediate (in-hospital) results of single-stage laparoscopic robot-assisted transperitoneal transvesical prostatectomy were analyzed in 55 patients with BPH who underwent surgery at the «Innomed – Center for Endosurgery» from 2019 to 2024 using da Vinci S and da Vinci Si surgical systems. To exclude prostate cancer, serum prostate-specific antigen (PSA) testing, MRI, and/or prostate biopsy were performed. Intraoperative blood loss was assessed by the gravimetric method. Surgical complications following prostatectomy were classified according to the Clavien-Dindo system, and urinary flow was evaluated before and after surgery using uroflowmetry. The mean age of patients was 66.7±4.3 years, mean body mass index – 25.6±3.5 kg/m², mean ASA (American Society of Anesthesiology) score – 1.8±0.2, mean prostate volume – 124.8±25.8 cm³, mean operative time – 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 stopped by electrocauterization of the prostate bed vessels. Blood transfusion was not required in any patient. Complications following laparoscopic robot-assisted prostatectomy occurred in one patient (1.8%) in the form of hyperthermia after urethral catheter removal, which was managed with antibacterial and anti-inflammatory therapy. Clavien-Dindo complications were observed in 2 (3.6%) patients, consistent with literature data. The mean maximum urinary flow rate (Q_max, ml/s) increased from 7.9±2.4 ml/s before surgery to 25.4±2.9 ml/s after surgery (p<0.05). Single-stage laparoscopic robot-assisted transperitoneal transvesical prostatectomy is associated with a minimal rate of postoperative complications and effectively restores urination in patients with large BPH (more than 80 cm³).