The Apical Dissection in Robot-Assisted Radical Prostatectomy

Prostate apex dissection during radical prostatectomy is a critical step to assure proper oncologic and functional outcomes. Understanding the prostate’s surgical anatomy, including shape variations, attachments, and urethral preservation, is vital. Preserving membranous urethra length is critical for continence recovery. Anatomic variations in the prostate apex shape can impact continence recovery, warranting preoperative MRI evaluation. The goals of apex dissection include complete prostate apex removal, maximal membranous urethra preservation, nerve-sparing when possible, and meticulous handling of vascular structures. Robot-assisted laparoscopic RP (RARP) enhances precision and anatomical understanding. The technique involves patient selection based on clinical factors and anatomy, precise dissection steps, and a focus on membranous urethra preservation. Tailoring the technique to disease status and patient anatomy is key.