title: Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.
abstract: OBJECTIVE
  The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy.
  
  
  METHODS
  The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002.
  
  
  METHODS
  Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed.
  
  
  CONCLUSIONS
  Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.
authors.affiliation: Department of Urology, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden. andreas.nilsson@karolinska.se
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Nilsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: Brett A
authors.initials: BA
authors.lastname: Laven
authors.forename: N Peter
authors.initials: NP
authors.lastname: Wiklund
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D011182:Postoperative Care; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D001743:Urinary Bladder / Q000601:surgery