Editing Robot-assisted Laparoscopic Prostatectomy (section)

=== Bladder Neck Reconstruction ===
* May be needed if a large defect is present, to narrow the diameter of the bladder neck opening to match the urethral diameter
* Technique[https://pubmed.ncbi.nlm.nih.gov/20858064/ §][https://pubmed.ncbi.nlm.nih.gov/18455623/ §][https://link.springer.com/chapter/10.1007/978-3-319-20645-5_25 §]
**Equipment: 2-0 Vicryl suture on SH needle, cut to 15-20cm
**Method 1 (anterior tennis racket closure)[https://link.springer.com/chapter/10.1007/978-3-319-20645-5_25 §]
***Proceed with the anastomosis as is usually performed, knowing that there will still be a substantial anterior bladder defect. Once the anastomotic sutures circumferentially complete the anastomosis, these sutures are tied together. 
***The anterior bladder neck defect is then closed in a side-to-side manner using 2-0 or 3-0 polyglactin sutures similar to bladder closures for other surgical procedures when the bladder has to be opened. This closure mimics a tennis racket and hence the name.
****See [https://link.springer.com/chapter/10.1007/978-3-319-20645-5_25#Fig6 Figure]
**Method 2 (posterior tennis racket closure)
***Figure-of-eight stitches inferiorly in the bladder neck (ie, tennis racquet closure).[https://pubmed.ncbi.nlm.nih.gov/20858064/ §]
***'''This inverting approach moves the UOs away from the anastomosis, thus avoiding a leak or inadvertent injury.'''
***See [https://www.urotoday.com/conference-highlights/eau-robotic-urology-section/erus-2018/106782-erus-2018-how-to-manage-complications-during-prostate-surgery.html Figure]
**Method 3 (fish-mouth closure)
***Interrupted sutures 
****From the 2-o’clock to the 4-o’clock position and the 8-o’clock to the 10-o’clock position on the bladder neck, closing it in a ‘‘fish mouth’’ configuration or in a ‘‘reverse tennis racket’’ approach.[https://pubmed.ncbi.nlm.nih.gov/18455623/ §]
****At 3 and 9 o’clock on the bladder neck and run medially until the bladder neck is of a sufficient size[https://link.springer.com/chapter/10.1007/978-3-319-20645-5_25][https://pubmed.ncbi.nlm.nih.gov/18455623/ §]
***** '''Caution: while feasible, this approach often involves placing sutures very close to the UOs.'''
*****See [https://link.springer.com/chapter/10.1007/978-3-319-20645-5_25#Fig5 Figure]
***Once this has been accomplished, the remainder of the anastomosis is continued in a usual manner.
**Additional sutures placed medially may be needed to narrow the diameter of the bladder neck opening to match the urethral diameter
* Once the bladder neck is complete, a standard running vesicourethral anastomosis is performed.