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Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy
Author(s) -
Tewari Ashutosh K.,
Rao Sandhya R.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06417.x
Subject(s) - medicine , prostatectomy , cadaveric spasm , neck of urinary bladder , surgery , urinary continence , anastomosis , robotic surgery , urology , urinary incontinence , urinary bladder , prostate , cancer
OBJECTIVE To develop a technique to identify the bladder neck during robotic radical prostatectomy (RRP) using anatomical and patient studies, and to evaluate its efficacy during and after surgery. PATIENTS AND METHODS The data for this study were from 10 fresh cadaveric dissections and 50 consecutive athermal RRPs performed at our institution. We used a technique we term ‘the bimanual bladder neck pinch’. RESULTS The technique helped us to identify the prostatovesical junction and to decrease the time required to dissect the bladder neck, and the time for urethrovesical anastomosis. Urinary continence requiring 0–1 pads was 29% at 1 week , 62% at 6 weeks, 88% at 12 weeks, and 95% at 16 weeks. No patient in the series had a clinically significant leak or urinary retention. CONCLUSIONS Our technique of the ‘bimanual pinch’ is easy to learn and has reduced the difficulty of bladder neck transection. It improved the outcome both during and after RRP in our series.