Urethtral approach in retroperitoneoscopic radical prostatectomy: a novel technique for safe prostate dissection

Laparoscopic radical prostatectomy (LRP) remains technically challenging and is associated with a steep learning curve. Prostate apex dissection (PAD) is one the most challenging elements of LRP. This study describes a novel technique for PAD using a transurethral approach (urethral assistance).

Through the transurethral route, Young's foreign body forceps is introduced under laparoscopic vision and both vas deferens are grasped for efficient traction of the prostate. The forceps is quickly clamped to the laparoscope holder. Urethral assistance facilitates more efficient dissection during dissection of the bladder neck, vas deferens, and seminal vesicles, transaction of the posterior prostatovesical junction, mobilization of the prostate off the rectum, and ligation of the dorsal venous complex.

In 10 patients with localized prostate cancer who underwent LRP using the urethral assistance technique, sufficient retraction of the prostate was maintained in the appropriate direction. No complications related to urethral assistance were observed. No internal or external instrument collisions occurred during PAD.

Urethral assistance provides a simple, reliable, cost-effective approach for performing PAD during LRP.