Hem-o-lok-free and Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

Background:Robot-assisted laparoscopic radical prostatectomy(RARP)has gradually become the standard surgical procedure for prostate cancer.This video,aimed to demonstrate a new and improved surgical approach for prostate cancerthat passes through the pouch of Douglas and allows retrograde release of the neurovascular bundle(NVB).The technique is Hem-o-lok-free and Retzius-sparing and is performed without opening the pelvic floor fascia during RARP.Methods:A 69-year-old man was diagnosed with prostate cancer(clinical stage T2bN0M0).We followed the process of Retzius-sparing RARP[published by Galfano et al.in 2013]and did some modification.The critical technical points associated with this technique included locating the fascial layer at the prostatic apex and performing complete retrograde release of the NVB along the anatomical structure.We used diathermy to perform precision hemostasis on large vessels,especially those around the basal part of prostate,with relatively less damage.In addition,Hem-o-lok was not used in this procedure.Results:Negative surgical margin and stage T2bN0M0 were confirmed.Continence was achieved immediately after catheter removal.One month after surgery,prostate specific antigen was undetectable.Erectile function was preserved 3 months postoperatively.Conclusions:Hem-o-lok-free and Retzius-sparing RARP is a feasible surgical approach that combines the benefits of complete retrograde release of the NVB,preserving the nerves and vascular structures around the prostate,protecting the pelvic floor structure,and ensuring rapid recovery of micturition control.