title: Management of large median and lateral intravesical lobes during robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  To describe a technique to manage large intravesical prostate lobes (IVPL) during robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  We used a "rescue stitch" to retract large IVPLs anteriorly out of the bladder lumen. This stitch is a 6-inch long 0-polyglactin suture on a CT-1 needle with a Hem-o-lok clip tied to the tail end. We deployed this through the IVPL from distal to proximal allowing the Hem-o-lok clip to sit against the lobe's distal aspect. The suture is grasped and pulled toward the symphysis, delivering the IVPL from the bladder lumen providing an unobstructed view of the posterior bladder neck (BN).
  
  
  RESULTS
  This was performed in 15 patients. Median (range) time to prepare and deploy the stitch(es) was 2 (0.5-3) and 5 (2-15) minutes, respectively. Five patients required >1 stitch. BN reconstruction was not needed. No patient had a positive margin at the BN.
  
  
  CONCLUSIONS
  Deploying a stitch allows anterior dynamic retraction of the prostate, facilitating the dissection of the posterior BN.
authors.affiliation: University of Southern California Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California , Los Angeles, California.
authors.forename: Andre Luis de Castro
authors.initials: AL
authors.lastname: Abreu
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.forename: Andre K
authors.initials: AK
authors.lastname: Berger
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
mesh_terms: D004867:Equipment Design; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*