• Our aim is to provide free detailed comprehensive manual for urologic surgical procedures. This site should serve as a valuable reference for urologic residents and medical students in training.

  • Robotic Radical Prostatectomy

    ABOUT THE AUTHOR

     

    Dr. Ali Moinzadeh MD

    Dr. Ali Moinzadeh MD

    Ali Moinzadeh, MD works at Lahey Clinic, Burlington, MA as the director of robotics in urology. He is fellowship trained for management of urologic cancers.  Dr. Moinzadeh uses the latest techniques with robotic and laparoscopic surgery to decrease patient pain and morbidity when feasible. He finished his undergraduate education at the University of Michigan, Ann Arbor. He then attended Northwestern University Medical School in Chicago, Illinois. Next he completed 2  years of general surgery residency at Massachusetts General Hospital, Boston, MA followed by 4 years of urology residency at Lahey Clinic, Burlington, MA. Finally he completed a two-year fellowship in Advanced Robotic and Laparoscopic Surgery at the Cleveland Clinic. As of November 2012, he has performed over 1,300 minimally invasive surgical procedures, including over 750 radical prostatectomy procedures (~850 robotic procedures), kidney (radical and partial nephrectomy), adrenal, ureter, and bladder surgeries. He played an integral part in the development and refinement of techniques for erectile nerve preservation during prostate removal for cancer. He has numerous publications in the field of urology.

    The next two videos are best for patient and medical student education


    Robotic Radical Prostatectomy Part I.

    Basic video demonstrating anatomic location of the prostate within the pelvis. Anatomic relationship of the prostate to surrounding structures is highlighted. Steps of RALP up to nerve sparing noted.


    Robotic Radical Part II, (nerve sparing)

    This video presents classic nerve sparing using clips. For a more advanced technique, see videos below.

     

    The following videos are best for urologist who perform robotic radical prostatectomy

     

    Entire video of RALP posterior approach condensed to ~40 minutes (minimal editing) Athermal technique of nerve sparing using bulldog.

    This ~ 40 minute video demonstrates a more advanced technique of performing the nerve sparing. We allow more blood loss for the sake of nerve sparing without the use of energy or clips. The video is meant for the more advanced surgeon. If you have not viewed the above videos, I would recommend reviewing them first.
    Above video is best for the advanced surgeon looking for the entire procedure

    The video highlights include:

    1. Posterior approach to SV and VAS Deferns.
    2. Sparing of accessory pudendal nerves.
    3. Bladder neck sparing dissection.
    4. Athermal technique of nerve sparing using bulldog.
    5. Cold dissection of DVC to allow for accessory pudendal artery sparing.
    6. Barbed suture anastomosis.

    Rationale for bull dog nerve sparing published in 2005, see link: Lateral pedicle control during laparoscopic radical prostatectomy: refined technique, Urology, Jan;65(1):23-7.

     

    Robotic Radical Prostatectomy:  Enlarged prostate and a median lobe.

    In the video below, we present techniques specifically for dealing with a prostate with an enlarged median lobe:

    1. Lateral dissection of the bladder to aid in bladder neck preservation
    2. Placement of suture to lift up the median lobe.
    3. Dissection of the median lobe at the prostate bladder neck junction, away from the ureteral orifice.

     

     

    Robotic Radical Prostatectomy in a Patient with Prior Laparoscopic Bilateral Hernia Repair with Mesh

    In this short ~3 minute video below, we present the dissection of the bladder off the pubic bone in a patient with prior lapaproscopic hernia repair with mesh.

     

     

    Anastomosis using barbed suture

    I have been using the barbed suture since 2009. It is an excellent suture for running anastomosis. Our early experience results have been published and may be found in the following link:  Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy. IBJU, 2012 Jan;38(1):89-96