Robotic Prostatectomy

Abstract

Placement of a trocar two fingerbreadths above the pubic symphysis in the midline improves retraction during the procedure, especially with upward mobilization of the seminal vesicles and vas deferens. I also use stay sutures placed at the base of the prostate, so that the assistant can better retract the prostate via the suprapubic port. This allows for easier development of the recto-prostatic plane. The third trick that I like to use is to over-inflate the Foley catheter just prior to division of the prostato-vesical junction and then have the assistant intermittently pull on the catheter to help define the bladder neck. I found that by doing this I can initially start my dissection sharp and then with the other assistant providing superior traction on the bladder and the assistant using the catheter, pulling the catheter upward, that this plane will develop very easily.