A novel technique for robotic prostatic adenomectomy: an evolution of transdouglas robotic prostatectomy

Bernardino De Concilio1, Guglielmo Zeccolini1, Pasquale Silvestre1, Adara Caruso1, Antonio Celia1
  • 1 Ospedale San Bassiano, S.C. Urologia (Bassano del Grappa)


Robotic prostate adenomectomy has nowadays an unclear role in the treatment of prostatic enlargement because of the leading role of endoscopic treatment. Only few reports are known about the use of robotic surgery for prostate benign enlargement. Transdouglas approach has been tested in order to perform prostatic adenomectomy for severe benign prostatic enlargement. Four 8 mm robotic trocars and one 12 mm trocar for the assistant are placed, as during robotic assisted radical prostatectomy. Transdouglas approach is performed in order to perform bladder neck sparing adenomectomy. The video shows the opening of the prostate capsule from below, according to the access to the prostate described by Bocciardi. The adenoma, together with the middle lobe, is split by the capsule from the base to the veru montanum. The adenomectomy so performed by transdouglas access is easy and quick. Blood loss is almost undetectable because the dissection is anatomical, helped by great vision and assisted by bipolar haemostays. After the enuclation of the adenoma, the bladder neck is sutured to the prostatic capsule and then it is closed by double layer watertight suture. Finally the peritoneum is sutured. Robotic Transdouglas prostate adenomectomy is safe and effective minimally invasive treatment for benign prostatic enlargement.