Apical Margins after Robot-Assisted Radical Prostatectomy: Does Technique Matter?

Abstract

Cold incision of the DVC before suture ligation reduces the rate of apical margin involvement during robot-assisted radical prostatectomy.

The Use of a Laparoscopic Bulldog Clamp to Control the Dorsal Vein Complex During Robot-Assisted Radical Prostatectomy: A Novel Technique

“…5, 6 Ahlering and associates 7 described the use of a vascular stapling device for DVC control, while some authors have preferred athermal division and selective suture ligation. 8,9 Suture ligation of the DVC may injure the urethra and external sphincter and decrease the functional urethral length. 10,11 Sometimes a DVC stitch may loosen and be dislocated during apical dissection and surgeons continue dissection of the dorsal vein, which may result in shortening of the urethral stump.…”

The Role of Staging MRI in Predicting Apical Margin Positivity for Robot-Assisted Laparoscopic Radical Prostatectomy

“…A method in which sharp transection of the DVC is carried out before ligation was recently reported for RARP. This method is associated with a decreased apical margin-positive rate and earlier return of postoperative continence [26,27]. Recently in our institute, we first loosely stitch the DVC at the apex so as not to disturb the structure of the urethral sphincter complex.…”

Robot-Assisted Radical Prostatectomy

“…Other proposed modifications include upfront cold transection of the DVC facilitated by increased pneumoperitoneum and its subsequent ligation. 42,43 Degree of Nerve Sparing Versus Cancer Control Before deciding how wide to dissect the neurovascular bundles, the surgeon must take into consideration the clinical patient data, including prostate biopsy findings, prostate-specific antigen levels, digital rectal examination findings, patient age, preoperative sexual function, and patient expectations, because different levels of nerve sparing can be considered based on these factors, and accordingly, different planes of dissection can be entered. Nerve sparing is not an all or none phenomenon, as it was believed to be.…”