Category: Robotic Surgery: New Techniques - Malignant
VS10-7 - Bladder Neck Sparing During Robot-Assisted Laparoscopic Prostatectomy: A Novel Technique
Introduction & Objective :
Some challenging surgical manouvers have the extreme importance for preserving the bladder neck and the internal circular sphincter during robot assisted laparoscopic radical prostatectomy (RALP). Herewith this video-abstract we would like to present our previously described novel surgical technique including dissection method for preserving the bladder neck, intrinsic sphincter and the preprostatic urethra.
Methods :
Adipose tissue anterior to the prostate and bladder neck was dissected and excised to expose clear visualization. Bladder, prostate and the zone between prostate and bladder were determined first. The energy of the monopolar scissors was reduced to 30 milliamps in this step and monopolar scissors dissected the space with its direction down at an approximately 20-30 degrees angle. After blunt dissection was performed, the urethra and the muscle fibers of the circular internal sphincter could be seen.
Results :
We identified an anatomic zone that comprises fatty connective tissues between the bladder neck and the prostate base. To our knowledge from the literature there is no detailed information for this zone in anatomic references and no name was given to this area. Estimated blood loss for this case including all steps was 30 cc. No complication was noted during and after the operation.
Conclusions :
Our novel technique provides very early continence at the time of catheter removal after RALP within short-term and long-term follow-up. This can help early recovery and develop QoL scores after RALP.
- EG
Eymen Gazel
– Urologist, acibadem, Ankara, Ankara, Turkey - EK
Engin Kaya
– Urologist, Ankara, Ankara, Turkey 
Serdar Yalcin
– Urologist, Ankara, Ankara, Turkey- SY
Sercan Yilmaz
– Nigde, Nigde, Turkey - HA
Halil Cagri Aybal
– Urologist, Ankara, Ankara, Turkey - EA
Esat Ak
– Mersin, Mersin, Turkey 
Lutfi Tunc
– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey