Robotic Assisted Laparoscopic Prostatectomy in Men with Proctocolectomy and Restorative Ileal Pouch-Anal Anastomosis

We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA) who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125？mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch. 1. Introduction Proctocolectomy with restorative ileal pouch-anal anastomosis (PC-IPAA) is commonly utilized for the treatment of familial adenomatous polyposis and medication-refractory ulcerative colitis, where long-term followup has demonstrated favorable functional and quality of life outcomes [1, 2]. Screening and treatment recommendations for men with prior history of PC-IPAA remain to be definitively assessed; however, radiation therapy is typically avoided due to concerns regarding injury to the pouch. Radical prostatectomy for localized prostate cancer presents unique challenges and has conventionally been performed using an open retropubic approach [3]. We present our surgical technique, outcomes, and feasibility assessment following robotic assisted laparoscopic prostatectomy (RALP). 2. Case Report Two patients with history of PC-IPAA for ulcerative colitis (UC) underwent RALP for clinically localized prostate cancer detected by PSA surveillance. The mean preoperative PSA was 9.1？ng/mL, and the mean age was 61 years. Both patients underwent transperineal prostate biopsies that demonstrated high volume Gleason score prostate adenocarcinoma. The operative approach included modified trocars placement under direct visualization, with additional assistant port used for extensive lysis of adhesions. Significant adhesions were encountered posteriorly with near encasement of seminal vesicles. Prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed in both patients. The integrity of ileal pouch was confirmed with gentle insufflation of air under vision.