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Updated: Aug 27, 2025

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Technical Tips in Managing Large Median Lobes During Robot-assisted Radical Prostatectomy.

Vinayak G Wagaskar1, Osama Zaytoun1,2, Priyanka Kale1

  • 1Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.

European Urology Open Science
|October 3, 2022
PubMed
Summary

Robot-assisted radical prostatectomy (RARP) for large median lobes requires more operative time and causes increased blood loss. However, this approach maintains similar cancer control rates compared to standard RARP procedures.

Keywords:
Prostate cancerRobot-assisted radical prostatectomySurgical technique

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • Large median lobes in prostate cancer present significant technical challenges during robot-assisted radical prostatectomy (RARP).
  • Difficulty in visualizing anatomical planes and potential for complications increase with larger prostates and median lobe protrusion.

Purpose of the Study:

  • To describe the surgical experience and outcomes of RARP in patients with large median lobes.
  • To identify technical tips to facilitate RARP and minimize complications in this patient cohort.

Main Methods:

  • Retrospective analysis of 2671 patients undergoing RARP, divided into groups with (n=260) and without (n=2411) a protruded median lobe (PML).
  • Preoperative MRI and intraoperative confirmation of PML were used.
  • Comparison of preoperative, intraoperative, and postoperative parameters between the two groups using statistical tests.

Main Results:

  • Patients with PML showed significantly higher prostate-specific antigen (PSA), PSA density, and International Prostate Symptom Score.
  • Group with PML experienced longer console and surgery times, and greater blood loss compared to the control group.
  • No statistically significant differences were observed in pathological stages or positive surgical margin rates between the groups.

Conclusions:

  • RARP for large median lobes is associated with increased operative time and blood loss but achieves comparable oncological outcomes.
  • Mastering key steps, particularly bladder neck dissection, is crucial for successful RARP in patients with large median lobes.
  • Adherence to specific surgical techniques can mitigate intraoperative risks and optimize patient outcomes.