Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy

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Abstract
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.