According to the recently updated AUA guideline on surgical management of very-large prostates (more than 150 grams in size), laser enucleation (HoLEP and ThuLEP) and simple prostatectomy (laparoscopic and robotic approach) are two available minimally invasive therapeutic options. Both alternatives provide excellent post-operative IPSS scores and maximal urinary flow rates with different drawbacks. Urethral stricture and incontinence are found to be less common in patients undergoing minimally invasive simple prostatectomy. However, blood transfusion requirements, operative time, and length of hospital stay are reported to be higher than those of HoLEP. At Ramathibodi Hospital, we are acquainted with robotic-assisted radical prostatectomy for the mainstay treatment of localized prostate cancer. Hence, the learning curve for robotic-assisted simple prostatectomy would be shorter compared to laser enucleation. Over the years, we have tried to improve the efficiency of this operation by minimizing operative time, estimated blood loss, and postoperative complications. To propose a comprehensive overview of robotic-assisted simple prostatectomy, this video presentation summarizes key procedural steps and highlights the advantages over traditional methods. We expect this video to be a part of training and skill development for urologic surgeons who are interested in the robotic approach.

The video was compiled and edited using CapCut software.

Following the successful 3-hour operation with an estimated blood loss of 400 ml, the Foley catheter can be removed on postoperative day 4 without requiring a test for anastomotic leakage. Besides patient satisfaction, the maximal urinary flow rate dramatically improved during the follow-up period.

Robotic-assisted simple prostatectomy is widely recognized as another minimally invasive therapeutic option for benign prostatic hyperplasia in which prostatic volume is more than 150 mL. We hope this video can probably serve as a practical guide for urologic surgeons to master operative skills and achieve excellent postoperative outcomes.