785 JOURNAL OF ENDOUROLOGY Volume 17, Number 9, November 2003 © Mary Ann Liebert, Inc. Vattikuti Institute Prostatectomy: A Single-Team Experience of 100 Cases MANI MENON, M.D., FACS, ALOK SHRIVASTAVA, M.D., RICHARD SARLE, M.D., ASHOK HEMAL, M.D., and ASHUTOSH TEWARI, M.D. ABSTRACT Purpose: To analyze the outcomes of the first 100 patients undergoing robotic radical prostatectomy by a sin- gle surgical team. Patients and Methods: From August 2001 to May 2002, we performed robotic radical prostatectomy in 100 patients with localized prostate cancer. The mean age was 60 6 0.67 years (SEM), the body mass index 27.5 6 0.35, the preoperative prostate specific antigen concentration 7.2 6 0.86 ng/mL, and follow-up 5.5 6 0.24 months. Thirty-eight patients also underwent pelvic lymph node dissection. We used the da Vinci™ surgical system and a subperitoneal approach (the Vattikuti Institute Prostatectomy; VIP). This is a prospective out- comes analysis of these patients. Results: The mean operating time was 195 6 5.0 minutes, and the mean blood loss was 149 6 11.8 mL. No patient required blood transfusion. The stages of the cancers were pT 2a in 21, pT 2b in 64, pT 3a in 5, pT 3b in 9, and pT 3b N 1 in 1. The positive surgical margin rate was 15%. At 1, 3, and 6 months, the continence rates were 37%, 72%, and 92%, respectively, and the potency rates were 11%, 32%, and 59%. Conclusion: The VIP is a safe operation with excellent operative parameters, low morbidity, and good sur- gical margins. The early functional results are promising. INTRODUCTION I N NOVEMBER 2000, Guy Vallancien performed the first robot-assisted radical prostatectomy using the da Vinci™ Surgical System (Intuitive Surgical, Sunnyvale, CA) at our in- stitution. 1 The procedure was implemented for the routine sur- gical care of patients with localized prostate cancer in March 2001. Our initial cases faithfully followed the principles de- veloped by Guillonneau and Vallancien 2 ; however, as we gained confidence, we reverted to our old instincts and devel- oped a procedure—the Vattikuti Institute Prostatectomy (VIP)—that resembles open radical prostatectomy more than its laparoscopic variant. 3 An important divergence from other ap- proaches is the performance of the entire procedure subperi- toneally after the ports have been placed transperitoneally. PATIENTS AND METHODS Study design The study was a prospective outcomes analysis of VIP in 100 consecutive patients with localized prostate cancer operated on between August 30, 2001, and May 9, 2002, by a single surgi- cal team. Each procedure was performed by a single surgeon (MM) assisted by a second-year urology resident (AT) and one of two fellows without previous residency training in urology (AS or RS). The chief surgeon had assisted in 50 laparoscopic prostatectomies and performed more than 1000 conventional radical retropubic prostatectomies (RRP) and 33 robotic prosta- tectomies prior to converting to the VIP technique. Patient selection The indications for VIP were identical to those of RRP. Pa- tients with localized prostate cancer were considered candidates if they were medically fit to undergo surgery and their weight was below 250 lb, although this restriction was relaxed in two patients (268 and 290 lb). Patients were excluded if they had significant comorbidity (Charlson Score .2; N 5 14, includ- ing 8 with obesity) or low-volume disease (,10% Gleason 6 on biopsy; N 5 26). Previous abdominal surgery was not an ex- clusion criterion: 26% of the patients had had abdominal sur- gery (9 hernia, 11 appendectomy, 8 laparotomy, some having more than one previous procedure). Six patients had laparo- scopic hernia repair with mesh. Three patients had previous Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.