Robotic-assisted radical prostatectomy: A surgical guide to the extraperitoneal approach

Christian Pavlovich, Adam C. Reese

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Robotic surgery is ideally suited for work in tight anatomic spaces within which there is a relatively small and static target. The prostate, with its typical size and central location in the pelvis, is a target organ that fits these criteria. In addition, its extraperitoneal location allows for access to the cancerous prostate without entry into the abdominal cavity. Extraperitoneal robotic-assisted radical prostatectomy uses an approach to the prostate that is identical to that used in open retropubic radical prostatectomy, with comparable avoidance of abdominal structures and of steep Trendelenburg position, but with fine robotic instruments as the surgical tools. The advantages of extraperitoneal robotic surgery to access and remove the prostate are only counterbalanced somewhat by an increased level of difficulty in learning to safely and reliably access the extraperitoneal space of Retzius, avoid or manage inadvertent peritoneotomy, and handle the posterior structures (seminal vesicles, vasa deferentia) in antegrade fashion. None of these hurdles are insurmountable, and virtually all patients can benefit from this approach. In fact, it is perhaps ideally suited for men who pose additional challenges to radical prostatectomy, such as the obese, those who have had prior abdominal or inguinal surgery, and/or those with concomitant inguinal hernia(s).

Original languageEnglish (US)
Title of host publicationRadical Prostatectomy: Surgical Perspectives
PublisherSpringer New York
Pages89-106
Number of pages18
ISBN (Electronic)9781461486930
ISBN (Print)9781461486923
DOIs
StatePublished - Jan 1 2014

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Robotics
Prostatectomy
Prostate
Head-Down Tilt
Abdominal Cavity
Seminal Vesicles
Groin
Inguinal Hernia
Pelvis
Surgical Instruments
Learning

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pavlovich, C., & Reese, A. C. (2014). Robotic-assisted radical prostatectomy: A surgical guide to the extraperitoneal approach. In Radical Prostatectomy: Surgical Perspectives (pp. 89-106). Springer New York. https://doi.org/10.1007/978-1-4614-8693-0_06

Robotic-assisted radical prostatectomy : A surgical guide to the extraperitoneal approach. / Pavlovich, Christian; Reese, Adam C.

Radical Prostatectomy: Surgical Perspectives. Springer New York, 2014. p. 89-106.

Research output: Chapter in Book/Report/Conference proceedingChapter

Pavlovich, C & Reese, AC 2014, Robotic-assisted radical prostatectomy: A surgical guide to the extraperitoneal approach. in Radical Prostatectomy: Surgical Perspectives. Springer New York, pp. 89-106. https://doi.org/10.1007/978-1-4614-8693-0_06
Pavlovich C, Reese AC. Robotic-assisted radical prostatectomy: A surgical guide to the extraperitoneal approach. In Radical Prostatectomy: Surgical Perspectives. Springer New York. 2014. p. 89-106 https://doi.org/10.1007/978-1-4614-8693-0_06
Pavlovich, Christian ; Reese, Adam C. / Robotic-assisted radical prostatectomy : A surgical guide to the extraperitoneal approach. Radical Prostatectomy: Surgical Perspectives. Springer New York, 2014. pp. 89-106
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