Salvage Robotic-Assisted Radical Prostatectomy after HIFU with HUGO™ RAS and a Comparison with Da Vinci Si® Platform

Introduction: Focal therapy is increasingly being utilized as a therapeutic alternative in the treatment of localized prostate cancer. High-intensity focused ultrasound (HIFU) has emerged as the most frequently used technology. Concurrent with the rise in treatment numbers, there has also been an increase in instances of local recurrence necessitating salvage therapy. Materials and Methods: This video shows two clinical cases of PCa submitted to HIFU that presented local recurrence: one patient with an infield recurrence (same area treated) and a second patient with an outfield recurrence (outside the HIFU treatment area). Both patients were submitted to a salvage robotic-assisted radical prostatectomy (RARP) approach, one using the da Vinci Xi (DV) platform (Intuitive Surgical, CA/USA) and the other HUGO™ RAS (HR) platform (Medtronic Limited, Watford, UK). We aim to demonstrate that salvage RARP can be performed in this new robotic platform. Results: A 52-year-old HR patient underwent focal therapy for an International Society of Urological Pathology (ISUP) grade three lesion in the left lobe. A 53-year-old DV patient, under active surveillance, chose focal therapy for three ISUP grade 1 fragments in the right lobe. Both procedures were uneventful, with console times of 105 minutes (HR) and 90 minutes (DV). Dissection began on the non-treated side, serving as a landmark, followed by the treated side. The HR platform replicated the DV technique, with challenges encountered due to fibrosis in the treated posterior plane. Postoperative PSA was undetectable in the DV patient and 0.054 in the HR patient at 45 days. Early functional outcomes: the DV patient had minimal leakage requiring 1 pad/day and erections firm enough for masturbation and foreplay with sildenafil and tadalafil. The HR patient had no urinary leakage, no pad requirements, and erections firm enough for intercourse. Conclusion: Performing RARP after HIFU is feasible with both robotic platforms, with more tissue fibrosis in the posterior plane on the treated side of the prostate. Conflicts of interest: None declared. Patient Consent Statement: “Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.” Runtime of video: 4 min 07 sec.