Step 5 Apical Dissection of the Prostate

Division of the Venous Complex

Incision of venous complex is performed following additional bipolar coagulation and then incising tangentially to avoid incision of the anterior surface of the prostate.

An avascular plane of dissection separating the urethra from the venous complex must be found underneath the venous complex. This plane allows complete identification of the prostate limits and urethra.

Some authors prefer introducing a metal bougie into the urethra to facilitate the apical dissection and improve tactile perception of the urethral wall.

Incision of the Urethra

The anterolateral urethral wall is incised with a cold knife or scissors and the tip of previously introduced urethral metal bougie is delivered through the anterior urethrotomy to open the urethral lumen and expose the posterior wall. The posterior wall of the urethra is incised similarly with the endoscissors under traction.

Incision of the Rectourethral Muscle

Rectourethral muscle appears relatively attenuated with this approach and represents the final attachment of the prostate. Division of the rectourethral muscle close to the prostate completely frees the specimen. The excised prostate is entrapped immediately in an endobag, which is temporarily positioned in the upper abdomen.

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