V4-12: Robotic Suprapubic prostatectomy- A Novel technique

Video

INTRODUCTION

The treatment of benign prostatic hypertrophy has evolved in many ways through technologic advances. Treatment options include endoscopic, open, laparoscopic, and robotic interventions. Simple robotic prostatectomy has been described using many different techniques including retrovesical, transvesical, and extraperitoneal approaches. In this video, we demonstrate a novel robotic approach to the simple suprapubic prostatectomy. The demonstrated technique is recognizable and easily adaptable for those skilled in radical robotic prostatectomy. _x000D_

METHODS

The start of this surgery is similar to radical approach with incision of the umbilical ligaments, dropping of the bladder, and incision of endopelvic fascia. The superficial venous complex is sutured. The bladder neck is dissected as we normally do for a robotic prostatectomy. The bladder neck is dissected until the Foley catheter is identified. The foley catheter is pulled anteriorly and used as a retractor. The prostatic adenoma can now be seen. The posterior bladder neck is now dissected. Verumontanum is identified. Dissection of the adenoma is begun posteriorly. Anteriorly, the lateral planes are established and this plane is continued all the way around to the very near to the apex of the prostate bilaterally. The anterior prostate is then divided in half to expose the anterior of the prostatic urethra. The adenoma is then removed. The distal apical urethral tissue was identified. The verumontanum is inspected and confirmed to be intact. #3-0 Quill suture is used to re-approximate the bladder neck to the urethra in a running fashion starting at the 5 o'clock position up until 12 o'clock position. An 18-French Foley catheter is placed and the remaining lateral bladder incision is closed with a running #3-0 V-lock._x000D_ _x000D_

RESULTS

This method has multiple advantages. It allows familiarity for those who have performed a radical robotic prostatectomy. In comparison with the open approach, it provides improved visualization. Our approach provides improved hemostasis. An 18 Fr catheter is placed at the end of the case. A suprapubic tube and continuous bladder irrigation are not necessary. This approach allows for quick recovery. Our patients are typically discharged on POD #1 with an indwelling Foley catheter. Given our watertight urethral approximation, the risk of urine leakage is very low._x000D_

CONCLUSION

In conclusion, our novel technique for robotic suprapubic simple prostatectomy is easily adaptable for those who are familiar with a robotic radical prostatectomy. The next steps of this study will be to assess for functional outcome after the procedure._x000D_

Funding: None