Surgical Hints for Robot-Assisted Transvesical Simple Prostatectomy

Objectives: To report a step-by-step technique for robot-assisted transvesical simple prostatectomy (RASP) focusing on surgical hints to facilitate the procedure. Methods: From January 2014 to April 2018 the institutional database was queried for consecutive patients undergoing RASP performed by a single-surgeon. Procedures were performed according to standardized steps as reported in the accompanying video. Ports were placed in a 'W' configuration. Surgery started with the bladder detachment, then the endopelvic fascia was exposed. The bladder neck was incised in a longitudinal fashion. Exposure of the adenoma was aided by using Keith needles. The bladder mucosa was incised and the dissection of the adenoma was performed till complete adenomectomy. Hemostasis of the enucleation bed was performed with electrocauterization. A 2-0 Polysorb suture was used for accomplishing the trigonization. Bladder closure was performed in double layer. A Foley catheter was inserted, then a water-tightness test was performed. Specimen was retrieved via the incision for the optical port. Results: Twenty-eight patients were performed, according to the described technique. Median prostate volume was 180 cm3. Median blood losses were 200 mL. No intraoperative complications were recorded. Four patients had minor complications (14%). Median catheterization time was 8 days. Regarding functional outcomes, patients had significant improvement of Qmax, postvoided residual volume, and international prostate symptom score at postoperative control (P < .001). Conclusion: RASP is feasible, safe and effective, and represents a viable approach to large adenomas. Prospective comparison with alternative minimally-invasive endoscopic techniques is warranted.