Identification and Repair of Rectal Injury During Da Vinci Prostatectomy with Prior SpaceOAR Placement

Clinical History: The patient is a 72-year-old man who underwent SpaceOAR hydrogel placement in preparation for brachytherapy for Gleason 4+3 prostate cancer at an outside hospital. However, interference from the pubic bone prevented brachytherapy seed placement. He was referred to our center for surgery. Physical Examination: Healthy-appearing man with large midline surgical scar from prior right partial colectomy. Diagnosis: Prostate cancer (Gleason 4+3 = 7). Intervention: An anterior approach radical prostatectomy was performed with the Intuitive Surgical da Vinci XI robot-assisted surgical system 75 days after SpaceOAR placement. No bowel preparation was performed. During the procedure, the posterior dissection planes were found to be significantly distorted because of the SpaceOAR. An injury to the rectum was identified ~1.5 hours into the operation. General surgery was consulted intraoperatively. As there was no gross contamination of the field, the rectal injury was closed primarily in two layers without diversion with an overlying peritoneal flap. A sigmoidoscopy was then performed intraoperatively, which revealed a watertight closure. The rest of the procedure was completed without any further complications. Final pathology analysis showed pT2N0 Gleason 4+3 prostate cancer with negative margins. Follow-Up/Outcomes: The patient experienced an iatrogenic rectal injury during a robot-assisted radical prostatectomy, likely related to the tissue distortion caused by the previously placed SpaceOAR as has been previously reported in the literature.1,2 The injury was repaired intraoperatively, with no further complications. The patient was discharged to home on postoperative day 5, and continues to do well as of his most recent follow-up 2 years postoperatively. The authors have no relevant or material financial interests that relate to the research described in this article and video production. Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music Copyright: Music featured in the video was obtained from www.royaltyfreemusicweb.com, and thus no copyright infringements have occurred as part of the production of this video. Runtime of video: 4 mins 49 secs