SRS260 - A new anatomical landmark: optimising surgical techniques in robotic prostatectomy

Abstract Retzius-sparing prostatectomy is an effective treatment for prostate cancer. The procedure can be challenging due to the lack of landmarks guiding surgeons to relevant anatomy. It uses a posterior approach, placing the surgeon near critical structures, including the ureters, iliac vessels, bladder trigone, and pedicles. Aim: To identify an anatomical landmark for surgeons to use during surgery, which should be consistent, easily identifiable, and ensure safe access to the peritoneum for prostatectomy. Methods: 50 videos of Retzius sparing prostatectomy were reviewed by Medical Students, Registrars, and a Consultant. The video was paused before the access incision, and each person was asked to identify the landmark they thought was being used by the surgeon. These images were then compared. Results: Of the 50 cases, there was 97% concurrence among registrars and 94% among medical students with the landmark. Discussion: The landmark was consistently identified by individuals of different experience levels with excellent reliability. The surgeon makes an inverted ‘U’ shape at the Transverse Retrovesical Intervasal Plexus (TRIP) lines, enabling appropriate access into the cavity without damaging at-risk structures. This suggests that the lines could be used as a landmark for surgeons and in training to improve the ease with which the skill is learnt and improve patient outcomes.