A technique for the management of a large median lobe in robot-assisted laparoscopic radical prostatectomy

An enlarged median lobe is encountered 8% to 18% of the time during robot-assisted laparoscopic prostatectomy. A large intravesical lobe can obscure the anatomy of the bladder neck and generate a large bladder neck, necessitating reconstruction. In addition, it may increase the likelihood of ureteral injury, positive surgical margin, and residual prostate tissue. When encountering this anatomic variant, a clear surgical plan is required. We describe our approach to the large median lobe and highlight a specific technique that may be beneficial in managing this anatomic variant.