Apical Dissection and Control of Dorsal Venous Complex

The lens is changed to 0°. The endopelvic fascia is scored and the space between the prostate and the levator ani is developed with blunt dissection. Cauterization should be minimized to avoid inadvertent injury to the neurovascular structures. The dissection is carried proximally until fat is seen at the junction of the prostate and bladder (Fig. 4). Distally, the dissection is carried just lateral to the puboprostatic ligaments that are left intact and just beyond the prostatic apex. Often the puboperinealis muscle is visible as a sling of muscle around the urethra just distal to the prostatic apex and care is taken to preserve this muscle (11). Next, the robotic instruments are changed to two needle drivers. A 6 to 9 0-Vicryl (polyglactin 910) suture on a CT-1 needle is used for a vertical mattress dorsal venous suture. The remainder of the suture is used for a prostatic traction suture placed just distal to the bladder neck.

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