Retzius-sparing robotic radical prostatectomy

Abstract

Traditional approach to the prostate during radical prostatectomy (RP) when performed by open, laparoscopic, or robotic means has been from its anterior aspect first and has involved suture ligation and division of the dorsal vein complex (DVC), division of the puboprostatic ligaments, and incision of the endopelvic fascia on either side of the prostate. These steps are necessary to liberate the prostate from its surrounding attachments, even though concern has always existed about the likely association between disruption of these structures and postprostatectomy incontinence (PPI). Although perineal prostatectomy leaves these structures intact, it has failed to become widely accepted because of the small incidence of postoperative fecal incontinence and the difficulty in performing a pelvic lymphadenectomy (PLND) when this is indicated.