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:
- Conceptualize the steps of the bladder neck dissection
- Describe 3 visual cues that could indicate incision into prostatic tissue
- Describe 3 maneuvers that can help visualization during the bladder neck dissection
- 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:
- 00:05. Incise fat lateral to the DVC.
- 00:41. Incise the detrusor apron in the midline.
- 02:16. Incise the anterior prostatovesical junction.
- 03:25. Open the anterior urethra.
- 03:28. Drop the anterior bladder lateral to the urethra.
- 06:34. Incise the posterior urethra.
- 06:41. Incise the posterior prostatovesical junction.
- 06:51 + 07:55. Incise the retrotrigonal fascia.
- 07:28 + 09:39 + 10:02. Perform hemostasis to the lateral vascular bladder attachments.
Surgical decision making and error avoidance cues:
Cognitive task analysis was performed to identify patterns and cues that expert surgeons use to inform their surgical decision-making and avoid errors.
Reference:
Lusty, A., Alexanian, J., Kitto, S., Wood, T., Lavallée, L. T., Morash, C., Cagiannos, I., Breau, R. H., & Raîche, I. (2024). How Surgeons Think to Avoid Error: A Case Study of the Neurovascular Bundle Sparing During a Robotic Prostatectomy. Journal of surgical education, 81(4), 570–577. https://doi.org/10.1016/j.jsurg.2024.01.009.
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.