Presentation - Sydney Adventist Hospital

Robotic radical
prostatectomy (RALP)
Dr Max Dias
Urological Surgery
Robotic Surgery
Sydney Adventist Hospital
S

Short history of radical
prostatectomy
S Prior to early 1980’s: Massive bleeding, incontinence, ED
and protracted recovery
S Mid 1980’s: anatomic nerve sparing radical prostatectomy
S 1992: first laparoscopic prostatectomy
S 2000: Vallencien- 1st robotic prostatectomy

Goals of surgical treatment of
prostate cancer
S Oncological (Cancer cure)
S Continence
S Potency

Apical dissection keys
1. Dissection of endopelvic fascia and pubo prostatic
ligaments
2. Dorsal vein suture
3. Apical retrograde NVB dissection
4. Retroprostatic apical dissection
5. Division of dorsal vein and urethra at apex (maximizing
urethral length)

Nerve dissection

Nerve dissection

Set up

Patient positioning

Incision

Port placement
8mm

Docking

Key Steps of RALP
1. Creating retropubic space
2. Division of bladder neck
3. Mobilization of seminal vesicle
4. Ligation of lateral pedicles
5. Apical dissection
6. Control of dorsal vein and division of urethra
7. Reconstruction - Urethrovesical anastomosis

Prostate anatomy

Nerve sparing

Surgical perspective

Ligation of dorsal vein

Division of Bladder Neck

Seminal Vesicle dissection and
Incision of Denovillier’s fascia

Dissection of neurovascular
bundle

Division of urethra

Urethro-vesical anastamosis