Radical Perineal Prostatectomy And Extended Pelvic Nodes Surgery

The following video shows a radical perineal prostatectomy (RPP) and simultaneous extended pelvic lymph node dissection. Radical perineal prostatectomy is an alternative to the retropubic, robotic-assisted or the laparoscopic approach. Advantages of RPP include the following: a small, hidden incision for better cosmesis, avoidance of major muscle groups, less pain and patient convalescence, faster return to work and strenuous activities, fewer adverse cardiovascular effects because fluid shifts are reduced, less blood loss, shorter operating time and duration of hospitalization, excellent posterior exposure to limit positive margins posteriorly, laterally and apically; precise watertight anastomosis performed under direct vision, easier for patients who are obese, avoidance of scar tissue from previous abdominal surgery, better visualization of the prostatic apex – the improved visualization of the apex facilitates avoidance of positive apical margins, sparing of neurovascular bundles, and visualization of the membranous urethra.