Cargando…
Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique
INTRODUCTION: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5–7], it is crucial to im...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Urologia
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482447/ https://www.ncbi.nlm.nih.gov/pubmed/37267619 http://dx.doi.org/10.1590/S1677-5538.IBJU.2023.0027 |
_version_ | 1785102176005128192 |
---|---|
author | Bravi, Carlo A. Mottaran, Angelo Sarchi, Luca Piro, Adele Paciotti, Marco Nocera, Luigi Balestrazzi, Eleonora Peraire, Maria Farinha, Rui Pauwaert, Kim Herwaarden, Manoe Van Vinckier, Marie-Hélène Backer, Pieter De D'Hondt, Frederiek Groote, Ruben De Naeyer, Geert De Mottrie, Alexandre |
author_facet | Bravi, Carlo A. Mottaran, Angelo Sarchi, Luca Piro, Adele Paciotti, Marco Nocera, Luigi Balestrazzi, Eleonora Peraire, Maria Farinha, Rui Pauwaert, Kim Herwaarden, Manoe Van Vinckier, Marie-Hélène Backer, Pieter De D'Hondt, Frederiek Groote, Ruben De Naeyer, Geert De Mottrie, Alexandre |
author_sort | Bravi, Carlo A. |
collection | PubMed |
description | INTRODUCTION: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5–7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). SURGICAL TECHNIQUE: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane – virtually until the seminal vesicles – prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. CONCLUSIONS: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention. |
format | Online Article Text |
id | pubmed-10482447 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Sociedade Brasileira de Urologia |
record_format | MEDLINE/PubMed |
spelling | pubmed-104824472023-09-07 Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique Bravi, Carlo A. Mottaran, Angelo Sarchi, Luca Piro, Adele Paciotti, Marco Nocera, Luigi Balestrazzi, Eleonora Peraire, Maria Farinha, Rui Pauwaert, Kim Herwaarden, Manoe Van Vinckier, Marie-Hélène Backer, Pieter De D'Hondt, Frederiek Groote, Ruben De Naeyer, Geert De Mottrie, Alexandre Int Braz J Urol Video Section INTRODUCTION: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5–7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). SURGICAL TECHNIQUE: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane – virtually until the seminal vesicles – prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. CONCLUSIONS: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention. Sociedade Brasileira de Urologia 2023-03-31 /pmc/articles/PMC10482447/ /pubmed/37267619 http://dx.doi.org/10.1590/S1677-5538.IBJU.2023.0027 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Video Section Bravi, Carlo A. Mottaran, Angelo Sarchi, Luca Piro, Adele Paciotti, Marco Nocera, Luigi Balestrazzi, Eleonora Peraire, Maria Farinha, Rui Pauwaert, Kim Herwaarden, Manoe Van Vinckier, Marie-Hélène Backer, Pieter De D'Hondt, Frederiek Groote, Ruben De Naeyer, Geert De Mottrie, Alexandre Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title | Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title_full | Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title_fullStr | Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title_full_unstemmed | Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title_short | Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique |
title_sort | different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the aalst technique |
topic | Video Section |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482447/ https://www.ncbi.nlm.nih.gov/pubmed/37267619 http://dx.doi.org/10.1590/S1677-5538.IBJU.2023.0027 |
work_keys_str_mv | AT bravicarloa differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT mottaranangelo differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT sarchiluca differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT piroadele differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT paciottimarco differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT noceraluigi differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT balestrazzieleonora differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT perairemaria differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT farinharui differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT pauwaertkim differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT herwaardenmanoevan differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT vinckiermariehelene differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT backerpieterde differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT dhondtfrederiek differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT grooterubende differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT naeyergeertde differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique AT mottriealexandre differentapproachesforbladderneckdissectionduringrobotassistedradicalprostatectomytheaalsttechnique |