12 Ces Urol 2024; 28(1): 10–12 VIDEO anastomosis without supporting reconstruction of the levator ani muscle Three thread turns are made without tension on No 5-8 and only then the stitch is gradually tightened The anastomosis at No 8-12 is completed, and the stump of the Santorini plexus is sutured ventral to the urethra The anastomosis is closed with the remainder of the first suture from No 5 in the ventral direction to No 12 The needles of both sutures are cut and both ends of the self-anchoring sutures are still tied Comment on the technique: The methodol‑ ogy has been used for over 10 years in more than 2,000 cases with satisfactory functional results, but the results have not been analysed in a high qual‑ ity study We do not routinely perform posterior reconstruction, this is also a given historically, when we did not perform it even in open procedures and we did not have more frequent complica‑ tions of urinary continence We perform posterior supportive reconstruction only very exceptionally when there is a large spacer defect after removal of the prostate, and in this case our intention is to reduce the tension of the subsequent anasto‑ mosis We perform the actual interruption of the urethra at the apex of the prostate with an effort to preserve the puboprostatic ligaments as much as possible, especially their distal fibres, which also go into the external bundle By subsequently tak‑ ing this area into a suture, we carry out a certain reconstruction of the suspension apparatus in the neck of the bladder and there is no decrease in this area We consider this front-upper reconstruc‑ tion to be more physiological than performing a routine posterior support reconstruction Our functional results, including economic aspects, have not forced us to change our strategy for more than 10 years Conclusion: The video presents one of the possible variants of urethrovesical anastomosis during robotic-assisted radical prostatectomy KEY WORDS Prostate cancer, prostatectomy robot, uretrovesical anastomosis LITERATURA 1. Doležel J, Tvarůžek J, Staník M, et al. Časné zkušenosti s roboticky asistovanou laparoskopickou radikální prostatektomií – prvních 153 pacientů Ces Urol 2009; 13(2): 168–77 2. Broďák M, Košina J, Balík M, et al. První zkušenosti s novým jednostranně ostnatým stehem V-Loc při laparoskopické radikální prostatektomii Ces Urol 2012; 16(3): 157–62 3. Novák K, Macek P, Vraný M, et al. Endoskopická extraperitoneální radikální prostatektomie a její kom‑ plikace – vlastní zkušenosti z prvních 300 operací Ces Urol 2014; 18(2): 119–27 4. Student V Jr, Vidlar A, Grepl M, et al. Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial Eur Urol 2017; 71(5): 822–830 5. Hora M, Stránský P, Ürge T, et al. Laparoskopická extraperitoneální radikální prostatektomie nervy šetřící – video Ces Urol 2017; 21(4): 268–71 6. Hoření E, Čermák M, Chmelík F, et al. Extraperitoneální robotická radikální prostatektomie s bilaterálním šetřením nervově‑cévních svazků Ces Urol 2018; 22(2): 84–6 7. Hora M, Ferda J, Pivovarčíková K, et al. Dorzální protuberance pubické symfýzy jako překážka provedení radikální prostatektomie Ces Urol 2021; 25(2): 137–9
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