The Posterior Approach to Transperitoneal Robot-Assisted Radical Prostatectomy: Detailed Technique

Abstract

Abstract Introduction: The technical description of laparoscopic prostatectomy from Montsouris1 included an initial posterior retrovesical approach to the vas and seminal vesicles, followed by Denonviller's fascia incision and posterior release of the rectum. At that time, the feasibility of dissecting these structures following the posterior bladder neck dissection was not known, and therefore the posterior approach was largely performed out of necessity. Currently, the majority of minimally invasive surgeons perform an anterior approach to the vas and seminal vesicle dissection, and the anatomy of an initial posterior dissection is therefore unfamiliar. Since April 2009, the senior author (D.C.) has switched to the posterior approach, and in this video the subjective advantages are discussed, and the technique demonstrated. Materials and Methods: Between April 2009 and April 2010, a posterior approach was attempted in 89 consecutive transperitoneal robotic prostatectomies. A four-arm DaVinci S-HD system...