Robotic Radical Prostatectomy

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Trocar Positioning: “Fusilli is better than Rigatoni!” – A trick to avoid/reduce gas-reabsorption
Processed with Snapseed.
Transperitoneal Approach
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Incision of the Peritoneum

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Surgical Anatomy

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Original Drawings by Ash Tewari

 

Bladder Neck: Tips & Tricks

Surgical Trick to manage a large TURP defect – Original Drawing by A. Erdem Canda

 

Lateral Approach for Median Lobe – Original Drawing by Alberto Pansadoro

 

Bladder Neck Sparing

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Hruby
Original Drawing and Comment by Stephan Hruby: “I found that there is a costant anastomotic detail after cleaning the Endopelvic Fascia from the fat: if you follow the fibres of the Puboprostatic Ligaments retrogradely, they constantly end up forming an “arcus” directly above the Bladder Neck, and vice versa fibres from the bladder also form an “arcus”. So after entering this line, I always encounter the Bladder Neck safely.

Posterior Dissection

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Nerve Sparing

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Incision of the the Endopelvic Fascia
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The Nerve of Levator Ani Muscle (preserve it to improve the postoperative urinary continence!)
The Neurovascular Bundle
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Complete vs Partial Nerve Sparing

 

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Original Drawings by Ash Tewari

 

Processed with Snapseed.
Nerve Sparing: Step by step
Processed with Snapseed.
The Prostatic Artery: A useful landmark
Processed with Snapseed.
Neurovascular Bundle

Santorini’s Management – The Urethra

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Santorini stitch during RARP – Original Drawing by Domenico Veneziano

Posterior Reconfiguration

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At the end of the prostatectomy…
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…you have to restore this geometry!
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CoRPUS: Complete Reconstruction of the Posterior Urethral Support
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The Rationale of CoRPUS!

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CoRPUS!

 

 

Rocco's stitch
Rocco Stitch – Original Drawing by Francesco Rocco

 

 

Urethro-Vesical Anastomosis

Original Drawings by Alex Mottrie

 

Other Tricks

“At start of the RARP the man is already in lithotomy position. Midline raphe incision. Bulbocavernosal muscle is preserved. The perineal body is visible where the posterior part of the muscle is held to the skin and anal sphincter. Dividing this will give far more mobility to the urethra when it comes to anastomosis and may avoid need for stitch posterior to the anastomosis which is always a concern that it may hit the sphincter. A study from Alabama (I think) put in an Advance in 50 men at the time of the RARP and all apparently were continent on removal of catheter (I have only heard this cohort described – may not have been published). What I have often considered is that perhaps the step of dividing the perineal body may what is crucial rather than the actual sling.”
Original drawing and comment by Paul Hegarty

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