Robotic laparoscopic radical prostatectomy with a single assistant - 23/08/11

Doi : 10.1016/j.urology.2004.01.043

David I. Lee ^a, Louis Eichel ^a, Douglas W. Skarecky ^a, Thomas E. Ahlering ^a,^⁎
^a Department of Urology, University of California, Irvine, Medical Center, Orange, California, USA

^*Reprint requests: Thomas E. Ahlering, M.D., Department of Urology, University of California, Irvine, Medical Center, 101 The City Drive South, Building 26, Route 81, Orange, CA 92868, USA

Abstract

Introduction

As experience with robot-assisted laparoscopic radical prostatectomy (rLRP) grows, the importance of the role of the assistant cannot be overstated. Key elements of the operation, dependent on the assistant, have not been reported. The focus of this report was to describe the key elements, which include positioning of the patient and assistant port sites, appropriate equipment, and the assistant-dependent steps of the procedure.

Technical considerations

During the course of the initial 100 cases, we reviewed the patient and port site positioning and reviewed the videotapes to identify key elements of the assistant's role that facilitate rLRP. We identified three important elements pertaining to patient positioning. In contrast to standard port site recommendations, we found that dominant and nondominant handedness dictate the assistant port site locations. Finally, we identified specific steps of the procedure that require the assistant to have laparoscopic skills necessary for the console surgeon to dissect the bladder neck, seminal vesicles, rectum, and neurovascular bundles.

Conclusions

The assistant in rLRP is critical to the success of rLRP, especially in the learning phases. Right or left-handed dominance determines on which side the assistant should be positioned. In contrast to the console surgeon, the assistant should have intermediate to advanced laparoscopic skills.

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