Mediathek

Abstract

Robotic extraperitoneal extravesical prostate adenomectomy with running suture of the bladder neck onto the intraprostatic urethra

M. Tutal¹, C. Padevit¹, K. Horton², H. John^2
1Kantonsspital Winterthur, Winterthur, Schweiz, ²Kantonsspital Winterthur, Urologie, Winterthur, Schweiz

We demonstrate our routinely preferred technique of robotic prostate adenomectomy with extraperitoneal approach, extravesical prostate adenomectomy and bladder neck reconstruction by running suture of the bladder neck with the intraprostatic urethra.

Standardized extraperitoneal access is performed with balloon dilatation and placement of a 4-arm daVinci Xi® System. The Santorini Plexus is ligated. The bladder neck is prepared and dissected around the indwelling catheter. Depending on the position of the ureteral orifices, ureteral stents are placed. The enucleation of the prostate gland is performed with blunt dissection and bipolar coagulation. Preliminary dorsal fixation of the bladder neck to the posterior prostate capsule is performed with 4-0 barbed suture to prevent further tension and minimize capsular bleeding. Thereafter, the urethral tract is reconstructed by direct continuous double armed suture 4-0 according to van Velthoven of the bladder neck with the intraprostatic urethral stump - thereby excluding the prostatic fossa totally. The prostate capsule is adapted onto the ventral bladder wall. A suprapubic catheter is placed.
No irrigation is needed, the indwelling catheter is removed after 24h-48h and the patient discharged after 2-3 days. Cystography excludes urinary leak after 5 days.
This extraperitoneal extravesical robotic adenomectomy provides a minimal invasive procedure in large BPH, thus avoiding significant blood loss, postoperative bleeding, infections and urgencies associated with the enucleated fossa, bladder neck stenosis and urethral injury. The demonstrated operative technique has become our standard after development of our Millin program over 10 years and more than 60 cases.