Single-Port Robotic Transvesical Simple Prostatectomy Step by Step

Abstract

We detail the instruments required to perform a single-port robotic transvesical simple prostatectomy, as well as the surgical technique to perform this operation using the single-port robot. A 3-cm transverse incision is made three fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The roll wound retractor rolling ring is inserted into the bladder lumen, with the access port, SP Short Entry Guide, and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mm Hg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-Loc suture from apex to base at 3-o-clock and 9-o-clock; a double-arm 3-0 V-Loc suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. Prostatic adenoma specimens can be removed from the SP Access Port directly or removed from the bladder using the robotic camera for observation. The cystotomy is closed in two layers with 3-0 Vicryl suture. The patient is observed for 2 hours on continuous bladder irrigation to determine ambulatory discharge eligibility. Follow-up is in 3 to 7 days for trial of void. Disclosure: Portions of this video and title were presented at the AUA 2023 in the form of a video abstract and as an AUA Core Curriculum video. https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000003288.06 Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. There are no commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Runtime of video: 7 mins 37 secs