Robotic simple prostatectomy: Patient selection, key steps - Stephen Summers, MD, and Ross Anderson, MD
Men with prostate glands >80-100 grams pose a unique challenge to urologists. Traditionally these men were treated with an open simple prostatectomy, but this operation has several risks and many urologists are reluctant to perform the procedure. Urologists are more facile with robotic procedures, and this video introduces several techniques for treating large prostates with a robot-assisted simple prostatectomy. Patient selection, key steps of the operation, and troubleshooting potential complications are reviewed.
Dr. Hotaling: This group uses a methodical and systematic approach to remove the adenoma. They initially release any adhesions and then develop the cystotomy site, open the bladder, and identify the ureteral orifices. Next, they perform the posterior plane dissection and extend this laterally to locate the apex and “shoulders” of the ademoma. Once removed, they obtain hemostasis and close. They do not place a double J ureteral stent but do temporarily catheterize the ureteral orifices to confirm the location of the orifices. The main advantage of their technique is the excellent visualization it affords for the procedure.
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