Skip to main content

Robot-Assisted Radical Prostatectomy for Large Glands and Median Lobe

  • Chapter
  • First Online:
Robotics in Genitourinary Surgery
  • 1020 Accesses

Abstract

Large prostates and median lobes can present challenging scenarios during robotic-assisted radical prostatectomy. They may complicate the performance of the bladder neck dissection. Median lobes may obscure identification of ureteral orifices and increase risk of ureteral injury and obstruction during urethrovesical anastomosis. Large prostates decrease the working space within the deep pelvis and may require reconstruction of the bladder neck. In this chapter, we discuss the management of large prostates, median lobes, and methods to reconstruct the large bladder neck.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Intuitive Surgical. Frequently asked questions 2015; Available at: http://www.intuitivesurgical.com/company/faqs.html. Accessed 06 Jan 2016.

  2. Tanagho EA, Nguyen HT. Embryology of the genitourinary system. In: Tanagho EA, McAninch JW, editors. Smith's general urology. 17th ed. New York, NY: McGraw-Hill Professional; 2007. p. 17–29.

    Google Scholar 

  3. Glenister TW. The development of the utricle and of the so-called 'middle' or 'median' lobe of the human prostate. J Anat. 1962;96:443–55.

    PubMed  PubMed Central  CAS  Google Scholar 

  4. Jenkins LC, Nogueira M, Wilding GE, Tan W, Kim HL, Mohler JL, et al. Median lobe in robot-assisted radical prostatectomy: evaluation and management. Urology. 2008;71(5):810–3.

    Article  PubMed  Google Scholar 

  5. Meeks JJ, Zhao L, Greco KA, Macejko A, Nadler RB. Impact of prostate median lobe anatomy on robotic-assisted laparoscopic prostatectomy. Urology. 2009;73(2):323–7.

    Article  PubMed  Google Scholar 

  6. Sarle R, Tewari A, Hemal AK, Menon M. Robotic-assisted anatomic radical prostatectomy: technical difficulties due to a large median lobe. Urol Int. 2005;74(1):92–4.

    Article  PubMed  Google Scholar 

  7. Rehman J, Chughtai B, Guru K, Shabsigh R, Samadi DB. Management of an enlarged median lobe with ureteral orifices at the margin of bladder neck during robotic-assisted laparoscopic prostatectomy. Can J Urol. 2009;16(1):4490–4.

    PubMed  Google Scholar 

  8. Jung H, Ngor E, Slezak JM, Chang A, Chien GW. Impact of median lobe anatomy: does its presence affect surgical margin rates during robot-assisted laparoscopic prostatectomy? J Endourol. 2012;26(5):457–60.

    Article  PubMed  Google Scholar 

  9. Coelho RF, Chauhan S, Guglielmetti GB, Orvieto MA, Sivaraman A, Palmer KJ, et al. Does the presence of median lobe affect outcomes of robot-assisted laparoscopic radical prostatectomy? J Endourol. 2012;26(3):264–70.

    Article  PubMed  Google Scholar 

  10. Huang AC, Kowalczyk KJ, Hevelone ND, Lipsitz SR, Yu HY, Plaster BA, et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59(4):595–603.

    Article  PubMed  Google Scholar 

  11. Jeong CW, Lee S, Oh JJ, Lee BK, Lee JK, Jeong SJ, et al. Quantification of median lobe protrusion and its impact on the base surgical margin status during robot-assisted laparoscopic prostatectomy. World J Urol. 2014;32(2):419–23.

    Article  PubMed  Google Scholar 

  12. Myers RP. Practical surgical anatomy for radical prostatectomy. Urol Clin North Am. 2001;28(3):473–90.

    Article  CAS  PubMed  Google Scholar 

  13. Chang CM, Moon D, Gianduzzo TR, Eden CG. The impact of prostate size in laparoscopic radical prostatectomy. Eur Urol. 2005;48(2):285–90.

    Article  CAS  PubMed  Google Scholar 

  14. Freedland SJ, Isaacs WB, Platz EA, Terris MK, Aronson WJ, Amling CL, et al. Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol. 2005;23(30):7546–54.

    Article  PubMed  Google Scholar 

  15. Frota R, Turna B, Santos BM, Lin YC, Gill IS, Aron M. The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy. BJU Int. 2008;101(5):589–93.

    Article  PubMed  Google Scholar 

  16. Hsu EI, Hong EK, Lepor H. Influence of body weight and prostate volume on intraoperative, perioperative, and postoperative outcomes after radical retropubic prostatectomy. Urology. 2003;61(3):601–6.

    Article  PubMed  Google Scholar 

  17. Yadav R, Tu JJ, Jhaveri J, Leung RA, Rao S, Tewari AK. Prostate volume and the incidence of extraprostatic extension: is there a relation? J Endourol. 2009;23(3):383–6.

    Article  PubMed  Google Scholar 

  18. Zorn KC, Orvieto MA, Mikhail AA, Gofrit ON, Lin S, Schaeffer AJ, et al. Effect of prostate weight on operative and postoperative outcomes of robotic-assisted laparoscopic prostatectomy. Urology. 2007;69(2):300–5.

    Article  PubMed  Google Scholar 

  19. El-Hakim A, Leung RA, Richstone L, Kim TS, Te AE, Tewari AK. Athermal Robotic Technique of prostatectomy in patients with large prostate glands (>75 g): technique and initial results. BJU Int. 2006;98(1):47–9.

    Article  PubMed  Google Scholar 

  20. Msezane LP, Gofrit ON, Lin S, Shalhav AL, Zagaja GP, Zorn KC. Prostate weight: an independent predictor for positive surgical margins during robotic-assisted laparoscopic radical prostatectomy. Can J Urol. 2007;14(5):3697–701.

    PubMed  Google Scholar 

  21. Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV. Impact of prostate size in robot-assisted radical prostatectomy. J Endourol. 2007;21(2):184–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raju Thomas .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lai, W., Boylu, U., Thomas, R. (2018). Robot-Assisted Radical Prostatectomy for Large Glands and Median Lobe. In: Hemal, A., Menon, M. (eds) Robotics in Genitourinary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20645-5_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20645-5_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20644-8

  • Online ISBN: 978-3-319-20645-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics