Intraperitoneal Approach

Schuessler's initial report described an intraperitoneal approach, with the surgeon first dissecting the vasa deferentia and seminal vesicles through the pouch of Douglas, and proceeding in an antegrade fashion (1). After Schuessler's description, the Montsouris technique, also using an intraperitoneal approach, was initially described in 1998 (14). The vesicular complex is dissected first, and then the bladder is dissected off the anterior abdominal wall allowing access to the Retzius space. The endopelvic fascia is opened and the dorsal venous complex is ligated. The bladder neck is then incised at the prostatovesical junction and the previously dissected seminal vesicles are exposed. After control of the lateral pedicle of the prostate, the neurovascular bundle preservation is performed from the base towards the apex. Finally, the urethra is transected and an interrupted urethrovesical anastomosis using 8-12 sutures is performed.

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