Name:
Robotic-assisted radical prostatectomy: Comparison and technique description using Da Vinci Xi® versus HUGO™ RAS robotic platform
Description:
Robotic-assisted radical prostatectomy: Comparison and technique description using Da Vinci Xi® versus HUGO™ RAS robotic platform
Thumbnail URL:
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/c7fee48b-27a3-4011-8d41-00841e4049c6
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/c7fee48b-27a3-4011-8d41-00841e4049c6/634652544-Duarteetalreviewmp4.mp4?sv=2019-02-02&sr=c&sig=6hYxBJX8%2B7tHrPQ2brfCUiMBKEWw%2FzjpGW5qUNQtfX4%3D&st=2026-03-09T19%3A11%3A46Z&se=2026-03-09T21%3A16%3A46Z&sp=r
Upload Date:
2024-10-24T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
SPEAKER: In this video, we will present a comparison of surgical techniques between the da Vinci Xi and HUGO RAS while performing robotic-assisted radical prostatectomy. This is our usual trocar placement for the da Vinci Xi. For HUGO platform, we made some minimal adjustments as shown in this picture. Camera port closer to the umbilicus, 12-millimeter assistant port cranial to the camera port. And the fourth robotic arm 3 centimeters cranial to ASIS.
SPEAKER: This is our surgical room layout tilt and angles. The patient is positioned in supine steep Trendelenburg position without any stirrups. Three robotic arms are positioned in the right side and one on the left side. We use two separate inflation systems without the use of Vinci Xi. We will present a simultaneous videos with the da Vinci Xi on your left and the HUGO RAS on your right.
SPEAKER: We start the procedure using 30-degree optics. After dropping the bladder, we start with the periprosthetic dissection. After identifying the bladder neck, the interior bladder neck dissection is performed using bipolar Maryland's and scissors. As we can see in this video, the image quality seems to be sharper with the HUGO RAS platform.
SPEAKER: With this new platform, we are still able to perform a blurring experiment technique. In our center, we have available a non-secure Cadiere forceps, which is not as strong as the secure Cadiere forceps or a toothed grasp. After identifying the vas deferens, we start the seminal vesicle dissection.
SPEAKER: First, medially. Then we proceed to dissection laterally to the seminal vessel. At these steps, it is important to reach the avascular plane of the seminal vesicle walls. When performing the lateral dissection, we avoid the use of monopolar energy, instead we use bipolar energy.
SPEAKER: After freeing both seminal vesicles, we start with the posterior dissection in an integrated fashion. With the Hugo platform, we are also able to control from the console the third degree upwards. In our technique, we start with the neurovascular bundle dissection posteriorly, going towards lateral.
SPEAKER: We place a haemal clip in the vascular pedicle in order to improve the posterior dissection. It is important to notice that the badasses showed some ergonomic challenges while placing clips. Caution should be taken while using the Hugo RAS scissors because it's sharper than the da Vinci Xi.
SPEAKER: As shown in this video, we proceed with the posterior dissection until reaching the apical region. We routinely perform an intra facial dissection if there is no signs of astrocyte extension in the MRI. In our technique, as we don't open the endopelvic fascia, we start using bipolar energy, the DVC close to the base of the prostate.
SPEAKER: And then proceed with dissection just posterior to the DVC. By doing this, the support of the pelvic floor is maintained. We do not perform a posterior reconstruction. We only place a single tool wiper stitch to support the anastomosis.
SPEAKER: It is important to notice that while using the Hugo RAS platform, we felt a wider range of motion for the neutral driver. Anastomosis is then performed using velox stitches. In conclusion, with minimal part placement adaptations, arm placement, and room setting, we are able to perform the same technique of robotic-assisted radical prostatectomy with this new platform with similar intraoperative outcomes.
