Radical prostatectomy, open

1. Lower midline. Open the retropubic space.
2. Node packet: open the sheath over the external iliac vein. Sweep nodes to the groin canal. Find the obturator nerve BEFORE dividing.
3. Endopelvic fascia opened beside the prostate.
4. Pubo-prostatic ligaments cut at their middle. Spare their urethral part.
5. Dorsal vein complex stitched under, right to left. Anchor to pubic bone (Walsh) optional.
6. Divide it under vision. Follow the prostate slope. The urethra appears at the apex.
7. Running 3/0 on the prostate top for back-bleeding.
8. Urethra: cut the front 2/3.
9. 6 stitches, 3/0 Monocryl, round the urethral edge. They finish the join later.
10. Back of the urethra cut between clamp and rectum.
11. Nerve spare: lateral pelvic fascia cut on its inner reflection. Free the bundle from apex upwards, behind Denonvilliers'. Clips only. NO diathermy near the bundle.
12. Bladder neck divided in front of the orifices. Vas clipped. Vesicle tip artery clipped. Out.
13. Tennis-racket neck repair, to 1 finger wide. (Sparing the neck does not change continence.)
14. Parachute join: 6 stitches through the neck. Catheter across. Bladder down. Knots: front first, back last.
15. Drains beside, not on, the join.

Robot-assisted, as animated

1. Camera and three 8 mm robotic arms in a line; assistant port separate. Steep head-down.
2. Retzius dropped. Endopelvic fascia opened each side.
3. Bladder neck opened at 12, at the prostate. Orifices stay with the bladder.
4. Vasa clipped and cut. Third arm lifts the vesicles.
5. Denonvilliers' opened below the vesicle tips. Stay on the fascia. Rectum is next.
6. Prostatic pedicles clipped at the base. NO energy beside the bundle. Bundles peel off laterally.
7. DVC controlled. Urethra cut at the apex, max length. Specimen into a bag.
8. Join: posterior row first, neck parachuted down, new catheter, anterior row. Leak test. Drain.
9. Bag out through the extended camera port.