Management of Large Median and Lateral Intravesical Lobes During Robot-Assisted Radical Prostatectomy

Purpose: To describe a technique to manage large intravesical prostate lobes (IVPL) during robot-assisted radical prostatectomy (RARP). Patients and Methods: We used a “rescue stitch” to retract large IVPLs anteriorly out of the bladder lumen. This stitch is a 6-inch long 0-polyglactin suture on a CT-1 needle with a Hem-o-lok clip tied to the tail end. We deployed this through the IVPL from distal to proximal allowing the Hem-o-lok clip to sit against the lobe's distal aspect. The suture is grasped and pulled toward the symphysis, delivering the IVPL from the bladder lumen providing an unobstructed view of the posterior bladder neck (BN). Results: This was performed in 15 patients. Median (range) time to prepare and deploy the stitch(es) was 2 (0.5–3) and 5 (2–15) minutes, respectively. Five patients required >1 stitch. BN reconstruction was not needed. No patient had a positive margin at the BN. Conclusions: Deploying a stitch allows anterior dynamic retraction of the prostate, facilitating the dissection of the posterior BN.