Posterior Approach to Seminal Vesicles

Abstract

The robotic assisted laparoscopic prostatectomy can be performed by several different approaches. In this technique, the surgeon incises the posterior peritoneum in the cul-de-sac between the sigmoid and the bladder. The seminal vesicles are identified and meticulously dissected in a caudal manner up to their confluence with the prostate. Denonvillier’s fascia is split or entered, and the dissection is then taken down to the level of the posterior urethra. By implementing a posterior approach for the seminal vesicle dissection, the surgeon is afforded several main advantages. An intact space of Retzius allows for improved working area during seminal vesicle dissection. By developing the rectoprostatic space, the assistant can easily access this area for improved suction irrigation to decrease pooling of blood during the procedure. Additionally, a surgeon may choose to use this type of approach for men who have a large prostate volume or have significant median lobes as this has been shown to decrease the operative time when compared to the anterior approach. There does not appear to be any difference in post-operative health related quality of life for men undergoing the posterior approach when compared to the anterior approach for radical prostatectomy. The posterior approach has been well documented in the literature and has been shown to be a safe and effective technique for seminal vesicle dissection. Any surgeon that performs radical prostatectomies should understand this approach and be able to utilize the technique when needed.