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


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.
Tewari
Ashutosh K
AK
Department of Urology, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA. ashtewari@med.cornell.edu
Rao
Sandhya R
SR
D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000033:anatomy & histology; D011468:Prostatectomy / Q000295:instrumentation / Q000592:standards*; D012371:Robotics; D001743:Urinary Bladder / Q000033:anatomy & histology* / Q000601:surgery*