Access to Retzius Space

Following the inspection of the abdomen, we divide the urachus and the both umbilical ligaments using monopolar endoscissor and bipolar endodissector, followed by incision of the peritoneum to the internal inguinal rings laterally. Traversing the light prepubic areolar tissue of the space of Retzius using sharp and blunt dissection exposing the pubic bone caudally as the first landmark and the external iliac vessels laterally, freeing the bladder from its anterior attachments. Then a sixth port (5 -mm) is placed in the right lower abdomen through which a grasping forceps is used to pull the urachus and dome of the bladder cranially. After that, the pelvic lymphadenectomy is carried out depending on the prostate-specific antigen (>10 ng/mL) and Gleason score (>6).

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