Robotic salvage prostatectomy for radio-recurrent prostate cancer

Introduction & Objectives: To demonstrate and highlight the technical difficulties in robotic salvage prostatectomy for radio recurrent prostate cancer. We also show the differences in technique for proton beam, external beam radiotherapy as well as Brachytherapy. Materials & Methods: This video exemplifies our technique for robotic salvage prostatectomy. We show prostatectomy in patients who have undergone primary external beam, proton beam and brachytherapy. The difference in the distortion of anatomy, the technique of obtaining a plane in the endopelvic fascia, posterior plane dissection, avoiding and recognizing rectal injury and nuances of apical dissection are described. Results: The video defines areas in which a cautious approach is necessary and highlights techniques needed to achieve a good Oncological outcome without complications.Though functional outcomes are not optimal the benefits of Oncological cure out weigh’s this aspect in salvage prostatectomy.Proton Beam radiotherapy is most difficult compared to external beam and Brachytherapy. Brachytherapy is relatively easier but the apical dissection may be difficult if the seeds have been placed outside the prostate. Conclusions: Robotic salvage prostatectomy for Radiorecurrent prostate cancer is a technically demanding procedure. There is a considerable learning curve to achieve an acceptable level of efficacy and safety. With careful attention to detail complications can be minimized.