“Double sandwich” technique for urethral separation during robotic-assisted radical prostatectomy
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Supported by “1255”Discipline Construction Foundation of Changhai Hospital.

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    Abstract:

    Objective To explore a technique for urethral separation in robotic-assisted radical prostatectomy. Methods After studying the anatomy of the urethra and the surround structures and watching the surgical video of robotic-assisted radical prostatectomy, we summarized the following six points of the "double sandwich" technique for urethral separation: to identify the golden eye, ligate the deep dorsal penile vein, approach via the slope road, sustained tension, relieve the lateral attachment of urethra, and pass through the plane between the urethral and Denonvilliers' fascia. From June 2013 to September 2013, a single surgeon performed 20 cases of robotic-assisted radical prostatectomy, including 14 cases of T2N0M0, and 3 cases of T3N0M0, 3 cases of T4N0M0 (with 3 months of neoadjuvant therapy). Results The procedures were successfully completed in all cases without conversion to open surgery, with the average operative time being (138 ±47.8) min, blood loss being (150±67.4) mL, and bladder-urethra anastomosis time being (13±6.5) min. "Double sandwich" technique was successfully used for urethral separation in 17 cases. Of the 3 cases with failed separation, 2 had basal tip adhesions and 1 had too much bleeding and affected the vision. The post-operation rate of urinary control was 64.7%(11/17)and the positive margin was noticed in 2(11.8%) of the 17 patients. Currently the patients were still followed up. Conclusion "Double sandwich" technique in robotic-assisted radical prostatectomy can separate the urethral anatomy, which may reduce the difficulty of bladder-urethra anastomosis.

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History
  • Received:December 09,2013
  • Revised:May 13,2014
  • Adopted:June 26,2014
  • Online: September 22,2014
  • Published:
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