RALP: Prostatectomy with wide local excision for high-risk PCa

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. 

This video demonstrates a wide-excision prostatectomy for patients with locally advanced, high-risk prostate cancer. Special emphasis is placed on early incision into Denonvillier's fascia and close dissection along the longitudinal muscle fibers of the rectum. An extended lymph node dissection is performed and emphasis is also placed on widely excising posterior lateral tissue as well as the bladder neck to help minimize positive margins in this very high-risk cohort.

The video demonstrates a bilateral wide-excision technique, but can be performed unilaterally should nerve sparing be possible on the contralateral side.

Dr. Hotaling: The techniques demonstrated in this video by Dr. Dechet-and also in a video by William J. Ellis, MD-are adaptations of classical open surgical radical retropubic prostatectomy by surgeons who were trained before robot-assisted laparoscopic prostatectomy (RALP) became widely available. The techniques shown by these two-high volume surgeons with excellent outcomes add to the armamentarium of the robotic prostate surgeon. 

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