Bladder neck dissection during a robot-assisted radical prostatectomy

Surgical decision making and error avoidance cues

Case specifics:

  • Robot-assisted radical prostatectomy—focus on the bladder neck dissection
  • Completed in 2020, Ottawa, ON, Canada at the The Ottawa Hospital.
  • Equipment: Da Vinci, Xi
  • Disease: pT1c, Gleason 4+3 prostate cancer.

 

Learning objectives:

  1. Conceptualize the steps of the bladder neck dissection
  2. Describe 3 visual cues that could indicate incision into prostatic tissue
  3. Describe 3 maneuvers that can help visualization during the bladder neck dissection
  4. List 2 visual cues that describe the retrotrigonal fascia


 Legend for video:

  • Blue circle/arrow = visual cues and landmarks
  • Purple arrow = maneuver

 

Steps of the bladder neck dissection. (Click forward options):

  1. 08:05. Incise fat lateral to the DVC.
  2. 08:43. Incise the detrusor apron in the midline.
  3. 09:42. Incise the anterior prostatovesical junction.
  4. 10:39. Open the anterior urethra.
  5. 10:40. Drop the anterior bladder lateral to the urethra.
  6. 13:17. Incise the posterior urethra.
  7. 13:24. Incise the posterior prostatovesical junction.
  8. 13:34 + 14:24. Incise the retrotrigonal fascia.
  9. 14:00 + 15:53 + 16:18. Perform hemostasis to the lateral vascular bladder attachments.

 

Ethical approval:

This project was approved by the University of Ottawa Research Ethics Board.

 

This project received fundings from:

AO Foundation in the context of the AOEI Fellowship in Medical Education research.