Robot-Assisted Laparoscopic Radical Prostatectomy: Management of the Difficult Case

Robot-assisted laparoscopic radical prostatectomy (RALP) can present unique challenges to the entire operating team. While the level of complexity of individual cases can be difficult to estimate preoperatively, several patient characteristics and variations in prostate anatomy can indicate that intraoperative challenges are likely to be encountered. These include obese and morbidly obese patients, patients with prior major abdominal surgery, large prostate size, and the presence of a median lobe or prior transurethral resection of the prostate (TURP). This chapter outlines these and other challenging scenario encountered during RALP and illustrates the techniques we use to overcome them. The accompanying video gives narrated examples of these scenarios.