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O, seodaemun-gu,seoul 120-752, korea. Tel: 82-2-2228-2318, fax: 82-2-312-2538e-mail: khrha@yuhs. Ac∙the authors have no financial conflicts ofinterest. viagra without a doctor prescription discount pharmacy viagra buy viagra canada viagra for sale online cheap viagra cheap pills viagra online forsale buy cheap viagra pills online generic viagra viagra for sale buy viagra online canada no prescription ⩠copyright:yonsei university college of medicine 2010introductioncase report page 2 patient’s prostate size, measured using ultrasonography,was 30. 7 cc, and his preoperative psa was 8. 88 ng/ml. With a clinical stage of t2c and a preoperative gleasonscore of 7 (3+4), the patient underwent rlrp. We haveused the transperitoneal approach and the fourth armduring rlrp for over cardinal cases. However, during thisparticular surgical procedure, we experienced a malfunc-tion of the fourth arm instrument. We used the prograsperforcep as our fourth arm instrument. Forcep function wasinitially unaffected; however, as the procedure progressed,the joint bolt began to slide-out farther, and forcep functionwas slightly decreased, limiting the use of the fourth arm. The surgeon did not initially experience notable difficul-ties. Following surgery, during the extraoperative period,the limit in forcep function was explored. As the forcepitself could not be removed, the trocar with the instrumentwas removed in whole unit form, leading to the discoveryof the loosened bolt which had impeded the removal of theforcep (fig. 1). The second assistant used a conventionallaparoscopic device for countertraction and grasping a. The operation was finished successfully. This instrumenthad been used previously in the rlrp of three otherconventional cases. Fortunately, this instrumental error didnot result in any problem during rlrp. The entire opera-tive time was 225 min and estimated blood loss was three hundredml. Overall, the surgery was successful with no otherintraoperative or perioperative complications, and thepostoperative hospital recovery course was normal. Rlrp is a new treatment option in the field of urology andis playing an increasing role in the surgical management ofprostate cancer. Many surgeons use the fourth arm duringrlrp. The fourth arm is useful as it can apply countertrac-tion. The presence of a fourth arm also makes solo-surgerypossible by taking the place of the patient-side surgeon. 5,6the most important issue to consider through our case isthat although the use of robotics in surgery has manyadvantages, because robots are mechanical devices, it isimperative that their mechanical function be checkedbefore surgery. In this way, mechanical malfunctions, suchas that presented in this. contact


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