Robotic salvage retropubic prostatectomy after radiation/brachytherapy: Initial results: Kaouk JH, Hafron J, Goel R, Haber GP, Jones JS, Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

Objective ort on the initial 4 patients who had robotic salvage retropubic prostatectomy (SRP) for biochemical recurrence after radiation therapy, and to review the surgical outcome of robotic cystoprostatectomy for bladder cancer in 2 patients who previously had prostate cancer. ts and Methods February 2006, 4 patients had SRP for biochemical failure after radiation and/or brachytherapy. Transrectal biopsy of the prostate confirmed locally recurrent disease and a metastatic evaluation including bone scan and computed tomography of the abdomen and pelvis were negative in all cases. The SRP was done using a six-port transperitoneal approach. An additional two patients had a robotic cystoprostatectomy for bladder cancer, in whom radiation was provided previously for prostate cancer. A retrospective analysis of the immediate and short-term surgical outcome was reviewed. s s completed in all patients with no major complication or conversion to an open approach. The mean operative duration was 125 minutes, the mean (range) blood loss was 117 (50–250) ml, and the mean hospital stay was 2.7 days. Of the 4 patients undergoing SRP, 3 had extracapsular extension and the first 2 had positive margins, while no patient had rectal injuries or significant blood loss. The lymph nodes were negative in all the patients. Three patients were continent within a month while 1 continued to use 2 to 3 pads/d at 3 weeks of follow-up. In the 2 patients who had cystoprostatectomy, there were no major complications or increased surgical difficulty. sions technically possible and with limited perioperative morbidity. Further studies are warranted to validate the oncological and functional outcomes of SRP after radiation and/or brachytherapy. Moreover, the robotic approach for radical cystoprostatectomy in patients who have had prostate radiation is feasible, with no increase in perioperative morbidity.