For benign prostate enlargement surgery, endourology surgery such as transurethral resection of prostate(TURP) or novel Minimally invasive surgical therapies(MIST) are the mainstay of the treatment options. However, endourology surgeries might not be feasible in cases with giant size of prostate. In such situation, simple prostatectomy should be considered. We describe an 82-year-old male with acute urinary retention and intermittent fever. Antibiotics treatment had been administered for 2 months, but intermittent fever still persisted. Also, worsening renal function was present, leading to hemodialysis. Inflammation scan showed increased signal uptake in prostate. Total prostate volume measured by CT was 796ml. Prominent intravesical growth of left lobe was noted. His PSA was 150, and the transrectal biopsy result was benign hyperplasia.

In November, 2024, the patient received Retzius sparing robotic assisted laparoscopic simple prostatectomy by Senhance system. Unlike typical simple prostatectomy surgery that initiate the incision and dissection from the bladder neck, we initiated the incision from left dome to perform enucleation of the left lobe of prostate. A hand port was additionally created to help us proceed distally to the apex. After removing the adenoma, bladder neck reconstruction and bladder wall repairment were completed.

The operation time was 4 hours and 39 minutes, with total blood loss 1300ml. The patient's fever subsided, and his renal function improved. Therefore, he was free from hemodialysis. No intraoperative or postoperative complications were noticed. Pathology showed nodular hyperplasia. Retrograde 1 month after the surgery showed no contrast leak, so foley was removed. The patient could void well with fair residual urine amount after foley removal.

For patient with intravesical growth of specific lobe, we could start incision at the specific side of the bladder wall in order to enucleate the prostate. We show that robotic assisted laparoscopic simple prostatectomy by Senhance system is safe and effective for patient with giant prostate.