Robotic Assisted Radical Prostatectomy: the Apical Dissection

The primary goal of robotic-assisted radical prostatectomy (RALP) is to completely remove the cancer and cure the patient of their carcinoma. Secondary goals of definitive therapy for prostate cancer include both the preservation of preoperative continence and potency. The apical dissection is one of the most crucial steps in the RALP. The dissection of the apex is the one part of this procedure in which the oncological outcome as well as the functional outcomes are in jeopardy if done inaccurately or incorrectly. The surgeon must clearly identify the apex of the prostate to avoid inadvertently entering the prostate and creating a positive surgical margin. The nerves are located in close proximity to the urethra and may be injured if not identified. Post-operative continence is also dependent on an accurate apical dissection. The rhabdosphincter should be clearly identified and a maximum functional urethral length should be maintained to prevent damage to these structures and to avoid postoperative incontinence. If the surgeon does not perform a meticulous dissection the “trifecta” of longterm cancer control, along with recovery of continence and sexual function will not be achieved [1].