Identification and preservation of accessory pudendal vessels during robot-assisted laparoscopic radical retropubic prostatectomy

The introduction of minimally invasive surgery for radical retropubic prostatectomy has increased the incidence of recognition of accessory pudendal arteries. Early identification and preservation of these vessels is paramount for optimal functional outcomes. In this article, we describe our robotic surgical technique for identification and preservation of both lateral and apical accessory pudendal arteries. The illuminated, magnified surgical field, the pneumoperitoneum which minimizes venous bleeding, and the ability to acutely angle the robotic instruments assists in the preservation of these arteries. Although anatomy precludes the preservation of all accessory pudendal arteries, adopting a strategic approach to robotic dissection allows accessory pudendal arteries to be successfully spared in most cases.