Patient positioning; incision/port placement

Positioning, incision, and port placement are critical to the safety and effectiveness of radical prostatectomy either open or robotic. For both approaches, there are variations in positioning that are acceptable and provider-dependent. A uniform feature of robotic positioning is a steep Trendelenburg position that mandates careful attention to securing and padding the patient. There are important physiological effects of Trendelenburg position that with pneumoperitoneum require both anesthesia and surgeon attention. Open or radical retropubic prostatectomy is performed supine with or without table flexion, and attention to patient padding is also critical. Certain patient factors may impact the safety of positioning including obesity and cardiopulmonary disease. Port placement for robotic surgery varies but there are general guidelines to port placement that minimize clashing of robotic arms and enable access to the membranous urethra. The incision for open surgery is standardized to the lower abdomen to enable access to the extraperitoneal space, though skin incisions may vary.