Category: Robotic Surgery: New Techniques - Malignant
Introduction & Objective :
To describe our prostatic apex preservation technique during robot assisted radical prostatectomy (RALP) for protection of external sphincter and save long enough urethra for vesicourethral anastomosis.
With the spread of robotic surgical techniques worldwide RALP has become the most comfortable surgical method in eligible prostate cancer patients. However, some important points that affect the success of the operation need to be clarified. Our technique for prostatic apex preservation is the most suitable technique for external sphincter protection and save long enough urethra for vesicourethral anastomosis.
Technique: Anterior dissection of the prostate is performed between the dorsal vein complex and prostatic fibromuscular stroma following the dorsal vein complex ligation. The anatomical space between DVC and prostate apex is filled by fat-rich connective tissue. With the dissection of this tissue by robotic closed scissor “U” shape space that the arms of “U” created by prostate apex may have easily. After the prostatic apex has clearly been seen urethra can be cut from the apex border to obtain an appropriate length of urethra for vesicourethral anastomosis. The appearance of verrumontanum during the cutting of the urethra is evidence of correct dissection.
Our prostatic apex preservation technique by giving the appropriate length of urethra and protecting the sphincter shows better postoperative results than other techniques. The main advantages of this technique are very early continence rates and less bladder neck stenosis risk.
Prostatic apex dissection is one of the most important steps of the RALP procedure. It effects both functional and oncologic outcomes. With our prostatic apex preservation technique, reduced incontinence rates, bladder neck stenosis complication and negative surgical margin in pathological reports are provided.
Serdar Yalcin– Urologist, Ankara, Ankara, Turkey
Engin Kaya– Urologist, Ankara, Ankara, Turkey
Eymen Gazel– Urologist, acibadem, Ankara, Ankara, Turkey
Halil Cagri Aybal– Urologist, Ankara, Ankara, Turkey
Tahsin Batuhan Aydogan– Urologist, Goksun, Kahramanmaras, Turkey
Mehmet Ezer– Mus, Mus, Turkey
Lutfi Tunc– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey
Ankara, Ankara, Turkey
Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey