Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has recently emerged as an alternative to standard RARP. Many studies over the years have demonstrated superiority of this approach in significant positive effect on the recovery of urinary continence. However, few cases were reported on RS-RARP performed on large prostate volumes. Here, we present the surgical steps of RS-RARP in a 74-year-old male patient with a large prostate using the DaVinci Xi System.

A 74-year-old male patient presented to our institution due to frequency and incomplete voiding for 6 months. Routine urological evaluation with elevated PSA levels (39.2 ng/mL) and MRI revealed prostate size of 130ml and multiple bilateral prostate lesions with PI-RADS category 5. MR fusion prostate biopsy showed prostate cancer in four target lesions, gleason score 4+3. Retzius-Sparing robot-assisted radical prostatectomy with bilateral lymph node dissection was performed.

Retzius-Sparing robot-assisted radical prostatectomy with bilateral lymph node dissection was performed. The console time was 136 minutes and the total operation time was 220 minutes. Intraoperative blood loss was 150ml. The length of his hospital stay was seven days. Pathology report showed acinar adenocarcinoma, Gleason score 4+5=9.

RS-RARP is more technically challenging than the standard RARP approach due to the limited working space, especially with large prostates. Here, we reported a case of RS-RARP performed on a 74-year-old male patient with a large prostate volume. Surgery was completed successfully without any intraoperative complications. This case demonstrates the feasibility of RS-RARP in the setting of a large prostate volume.