The LAPE pouch: A solution to specimen storage in total extra-peritoneal RLRP

Abstract

Introduction: We describe a novel creation of a triangular extra-peritoneal space bounded by the lateral abdominal wall laterally, peritoneal reflection medially and inferior epigastric vessels distally (the LAPE pouch) that serves as an ideal entrapment pouch for specimen storage in TEP-RLRP. Patients and methodology: 50 consecutive patients underwent TEP-RLRP with the creation of the LAPE pouch for specimen storage. Inclusion criteria for TEP-RLRP were: (1) BMI ≤35 kg/m2, and (2) MRI prostate volume of ≤80 ml. Patient's demographics, intraoperative data (LAPE creation time, blood loss) and post-operative complications were analyzed. The step-by-step technique of LAPE pouch creation is as follows: (1) creation of extra-peritoneal space; (2) identification of key anatomical boundaries; (3) blunt dissection to create the LAPE pouch; (4) the fourth robotic port insertion at the tip of the LAPE triangular. Results: The mean age of patients was 66 years (51–77), mean BMI of 24.6 kg/m2 (19.8–34.8), mean PSA of 7.9 ng/ml (1.4–18), and mean MRI-measured prostate volume of 45.1 ml (20–80). Mean dissection time for LAPE pouch was 1.4 min (1.0–3.1). All specimens were successfully placed in the pouch with only one (2%) specimen displacement after placement intraoperatively. There were no complications because of LAPE pouch creation or use. Mean final prostate size corresponds well with MRI-measured prostate volume (47.9 gram vs 45.1 ml). Conclusions: This study presents a novel, safe and easy technique in creating an additional triangular extra-peritoneal space that overcome the pitfall of TEP RLRP in specimen storage.

Keywords

• Total extra-peritoneal
• Robotic-assisted laparoscopic radical prostatectomy
• Surgical technique