title: Transurethral marking incision of the bladder neck: a helpful technique in robot-assisted laparoscopic radical prostatectomy involving post-transurethral resection of the prostate and cancers protruding into the bladder neck.
abstract: BACKGROUND
  Bladder neck transection is one of the most difficult procedures for robot-assisted laparoscopic radical prostatectomy (RALP), particularly in patients who have undergone previous transurethral resection of the prostate (TUR-P), and in those with large median lobes or prostate cancer protruding into the bladder neck. To ensure negative surgical margins and safely preserve the ureteral orifices during bladder neck transection, we propose the use of the transurethral resectoscope for making the incision in the bladder neck before initiating RALP. Thus, we developed a technique for bladder neck transection to facilitate this operation in such patients.
  
  
  METHODS
  Two Japanese men, aged 61 and 63 years, who were diagnosed with prostate cancer, received a transurethral marking incision of the bladder neck before starting RALP; prostate cancer developed in one patient after TUR-P and the other patient had cancer protruding into the bladder neck. A transurethral resectoscope was used to closely observe the ureteral orifices and bladder necks; the bladder necks were marked to indicate the depth from the mucosa to the muscular layer. During the RALP, the bladder necks were dissected to indicate the depth of the marking incision. The surgical margins were negative and perioperative complications did not occur. The Foley catheters were removed on postoperative day 6, according to the usual protocol. No urinary leakage from the anastomosis sites was observed.
  
  
  CONCLUSIONS
  This technique, involving the use of an ordinary transurethral resectoscope, may be an easy procedure to ensure negative surgical margins, safely preserve the ureteral orifices, avoid increasing the bladder neck diameter, and achieve a good quality vesicourethral anastomosis that prevents the risk of suture-related tissue tears.
authors: Satoshi
authors: S
authors: Kurokawa
authors: Keiichi
authors: K
authors: Tozawa
authors: Yukihiro
authors: Y
authors: Umemoto
authors: Takahiro
authors: T
authors: Yasui
authors: Kentaro
authors: K
authors: Mizuno
authors: Atsushi
authors: A
authors: Okada
authors: Noriyasu
authors: N
authors: Kawai
authors: Yutaro
authors: Y
authors: Hayashi
authors: Kenjiro
authors: K
authors: Kohri
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000379:methods*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012371:Robotics / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
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