V4-14: Robot assisted Millin Prostatectomy
VideoIntroductions and Objectives
Robot assisted Millin prostatectomy has demonstrated to be an effective treatment for large benign prostate hyperplasia (BPH). This video highlights surgical steps of this procedure.
With the patient in steep Trendelemburg position a 5 trocar access was performed. The prostate-bladder junction was identified; the ventral aspect of prostatic lobes was progressively dissected up to identify the apex and the urethra. The urethra was transected and the bladder catheter secured with an hem-o-lock. With a traction applied to the catheter the lateral and the posterior aspects of the lobes were isolated. The bladder neck was then transected and the posterior aspect of the lobes completely cleaved. Hemostasis of the prostatic fossa was obtained with monopolar coagulation and trigonization performed with a 2/0 monocryl running suture. Finally, the lateral and the ventral aspects of the bladder neck were approximated with the ventral and lateral aspects of the bladder neck, respectively.
Operative time was 75 minutes. Intraoperative estimated blood was 200 mL. The patient was discharged on first postoperative day and the urethral catheter was removed on 3rd postoperative day. Prostate weight was 85 grams.
Robot assisted Millin prostatectomy is a feasible technique that may be successfully applied to large BPH as alternative to endoscopic treatments.