title: Use of the Endoholder device during robotic-assisted laparoscopic radical prostatectomy: the "poor man's" fourth arm equivalent.
abstract: OBJECTIVE
  During standard, six-port set-up, robotic-assisted laparoscopic radical prostatectomy (RLRP) using a three-arm daVinci system (DVS), two assistants are routinely required. The role of the second assistant is often limited to isometric traction during prostate dissection. Due to muscle fatigue and inability of the operator to see the operative field, frequent repositioning of the second assistant is often required.
  
  
  METHODS
  In an attempt to improve efficiency in such surgical situations, we describe the use of the Endoholder, an adjustable articulating instrument holder, to assist during RLRP.
  
  
  RESULTS
  During 100 consecutive cases, the Endoholder provided quick, reproducible retraction to facilitate exposure. No complications occurred with its use. The device reduced the need for a dedicated second assistant to stand bedside.
  
  
  CONCLUSIONS
  We have achieved significant improvements in the safety and efficiency of retraction of the rectum, bladder, and prostate during RLRP with the Endoholder. For urologists working with a three-armed DVS, use of the Endoholder may help facilitate tissue retraction during dissection.
authors.affiliation: Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA. kevinzorn@hotmail.com
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Zagaja
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
mesh_terms: D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011468:Prostatectomy / Q000295:instrumentation*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation*