Skip to main content

Step-by-Step Approach to Robotic-Assisted Radical Prostatectomy

  • Chapter
  • First Online:
Robotic Urologic Surgery

Abstract

Robotic surgery is constantly evolving since the first procedure was cleared by the FDA (Food and Drug Administration) in 2000. Despite the technological advancements provided by successive generations of the da Vinci Robot, urinary continence and erectile dysfunction are still unpredictable following robotic-assisted radical prostatectomy (RARP). In this scenario, the surgical technique is continuously evolving because functional and oncological outcomes still did not reach 100%. This chapter describes the details of our most recent RARP technique after performing more than 15,000 RARP. We also will describe some technique variations performed by another prostate cancer referral center.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bhat KRS, Moschovas MC, Onol FF, Rogers T, Reddy SS, Corder C, Roof S, Patel VR. Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases. J Robot Surg 2020 Oct 10. https://doi.org/10.1007/s11701-020-01157-5. Epub ahead of print.

  2. Basourakos SP, Kowalczyk KJ, Moschovas M, Dudley V, Shoag JE, Patel V, Hu JC. Robot-assisted radical prostatectomy maneuvers to attenuate erectile dysfunction: technical description and video compilation. J Endourol 2021 May 20. https://doi.org/10.1089/end.2021.0081. Epub ahead of print.

  3. Kumar A, Patel VR, Panaiyadiyan S, Seetharam Bhat KR, Moschovas MC, Nayak B. Nerve-sparing robot-assisted radical prostatectomy: current perspectives. Asian J Urol. 2021 Jan;8(1):2–13. https://doi.org/10.1016/j.ajur.2020.05.012. Epub 2020 Jun 11. PMID: 33569267; PMCID: PMC7859364.

  4. Martini A, Falagario UG, Villers A, Dell'Oglio P, Mazzone E, Autorino R, Moschovas MC, Buscarini M, Bravi CA, Briganti A, Sawczyn G, Kaouk J, Menon M, Secco S, Bocciardi AM, Wang G, Zhou X, Porpiglia F, Mottrie A, Patel V, Tewari AK, Montorsi F, Gaston R, Wiklund NP, Hemal AK. Contemporary techniques of prostate dissection for robot-assisted prostatectomy. Eur Urol 2020 Oct;78(4):583–591. https://doi.org/10.1016/j.eururo.2020.07.017. Epub 2020 Aug 1.

  5. Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta- analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62:405–17.

    Article  PubMed  Google Scholar 

  6. Ficarra V, Novara G, Ahlering TE, et al. Systematic review and meta- analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62:418–30.

    Article  PubMed  Google Scholar 

  7. Covas Moschovas M, Bhat S, Onol FF, Rogers T, Roof S, Mazzone E, Mottrie A, Patel V. Modified apical dissection and lateral prostatic fascia preservation improves early postoperative functional recovery in robotic-assisted laparoscopic radical prostatectomy: results from a propensity score-matched analysis. Eur Urol 2020 Dec;78(6):875–884. https://doi.org/10.1016/j.eururo.2020.05.041. Epub 2020 Jun 24.

  8. Bhat KRS, Moschovas MC, Sandri M, Dell'Oglio P, Onol FF, Rogers T, Reddy S, Noel J, Roof S, Sighinolfi MC, Rocco B, Patel VR. A predictive pre- and post-operative nomogram for post-operative potency recovery after robot-assisted radical prostatectomy. J Urol. 2021; https://doi.org/10.1097/JU.0000000000001895.

  9. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) con- sensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40:244–52.

    Article  PubMed  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA. Classification of surgical com- plications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rogers T, Bhat KRS, Moschovas M. Use of transversus abdominis plain block to decrease pain score and narcotic use following robotic-assisted laparoscopic radical prostatectomy. J Robot Surg. 2020 Apr 22; https://doi.org/10.1007/s11701-020-01064-9.

  12. Muraoka K, Hinata N, Morizane S, Honda M, Sejima T, Murakami G, et al. Site-dependent and interindividual variations in Denonvilliers’ fascia: a histological study using donated elderly male cadavers. BMC Urol. 2015 May;15:42.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer KJ, Patel VR. Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 2012 Apr;61(4):796–802. https://doi.org/10.1016/j.eururo.2011.12.048. Epub 2012 Jan 4.

  14. Patel VR, Schatloff O, Chauhan S, et al. The role of the prostatic vasculature as a landmark for nerve sparing during robot-assisted radical prostatec- tomy. Eur Urol. 2012;61(3):571–6.

    Article  PubMed  Google Scholar 

  15. Nishimura M, Utsugi R. Impact of total fascia preservation on early recovery of urinary continence after radical prostatectomy. J Clin Urol. 2018;11(4):293–8.

    Article  Google Scholar 

  16. Kwon SY, Lee JN, Kim HT, Kim TH, Kim BW, Choi GS, et al. Endopelvic fascia preservation during robot-assisted laparoscopic radical prostatectomy: does it affect urinary incontinence? Scand J Urol. 2014;48(6):506–12.

    Article  PubMed  Google Scholar 

  17. Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, Menon M, Montorsi F, Myers RP, Rocco B, Villers A. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 2010 Feb;57(2):179–192. https://doi.org/10.1016/j.eururo.2009.11.009. Epub 2009 Nov 11.

  18. Rocco B, Cozzi G, Spinelli MG, Coelho RF, Patel VR, Tewari A, Wiklund P, Graefen M, Mottrie A, Gaboardi F, Gill IS, Montorsi F, Artibani W, Rocco F. Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol. 2012 Nov;62(5):779–90. https://doi.org/10.1016/j.eururo.2012.05.041.

    Article  PubMed  Google Scholar 

  19. Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho RF, Palmer KJ, Davila H, Patel VR. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy. Actas Urol Esp. 2012 Feb;36(2):69–74.

    Article  CAS  PubMed  Google Scholar 

  20. Walsh PC. Anatomic radical retropubic prostatectomy. In: Walsh PC, Retik AB, Vaughan Jr ED, Wein AJ, editors. Campbell’s urology, Chapter 86, vol. III. 7th ed. Philadelphia, WB Saunders; 1997. p. 2565–88.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moschovas, M.C., Palmer, K.J., Maes, K., Alves, L., Patel, V. (2022). Step-by-Step Approach to Robotic-Assisted Radical Prostatectomy. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-00363-9_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-00362-2

  • Online ISBN: 978-3-031-00363-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics