A novel technique of exposure during radical retropubic prostatectomy

We describe a novel technique of enhanced exposure during radical retropubic prostatectomy in cases with significant cartilage overgrowth at the junction of the symphysis pubis.

At our institution 74 radical retropubic prostatectomies were performed between July 1, 1998 and June 30, 1999. In 9 cases (12%) exposure was limited by overgrowth of cartilage at the posterior aspect of the pubic symphysis. Electrovaporization of this cartilaginous outgrowth was performed using an extended Bovie tip on cut settings of approximately 250 W. using the Bard System 5000, Birtcher 5000 and 6400 series (Valley Lab, Boulder, Colorado). The cartilage was vaporized until flush with the pubic bone.

This technique provided optimal exposure for direct visualization during the most critical part of the procedure. Added operative time was only 1 to 3 minutes. No intraoperative or postoperative complications were associated with this technique.

We recommend this technique of vaporization when surgical exposure is limited by overhanging pubic symphysis cartilage. This technique enables better visualization during apical dissection, control of the dorsal vein complex and division of the urethra without additional operative time or surgical complications.