Indocyanine green guided urethra-sparing robot assisted Millin’s prostatectomy
Abstract
INTRODUCTION: Millin's prostatectomy is an established surgical option for large benign prostatic hyperplasia (BPH). The main pitfalls of surgical options remain the retrograde ejaculation, to date considered an intrinsic side effect of surgery.
METHODS: In this video we first report surgical steps of a robot assisted Millin's prostatectomy with complete preservation of prostatic urethra in order to preserve antegrade ejaculation.
The first step was a retrograde injection of 10 mL of indocyanine green through the urethral catheter placed at navicular fossa.
Near infrared fluorescence (NIRF) imaging was used when dissection moved towards the median aspect of the lobe in order to improve visualization of the bladder neck and of the urethra, to avoid any unintended violation of urinary tract.
RESULTS: Operative time was 115 minutes. Estimated blood loss was 100 mL. Continuous bladder irrigation was not necessary. Urethral catheter was removed on third postoperative day. Patients was discharged on 4th postoperative day.
On final pathology, 75 grams of benign hyperplastic tissue were confirmed.
At 1 month evaluation, IPSS score decreased from 22 to 8, and patient reported a satisfying antegrade ejaculation.
CONCLUSIONS: We first described a NIRF imaging guided technique to perform robot assisted urethra sparing Millin's prostatectomy with preservation of ejaculatory function.