To describe the surgical technique and evaluate the feasibility of robotic-assisted preperitoneal prostate adenomectomy for large benign adenomas in a pilot series.

A total of 13 consecutive patients with a median age 70 years and body mass index of 26 kg/m² in whom open adenomectomy was planned were included in this pilot study. The extraperitoneal robotic approach was standardized in all cases. The demographic, operative, and outcome measurements were analyzed. The conversion rate, total operative time, and blood loss served as the feasibility parameters.

The total operative time was 210 minutes (range 150-330). No open conversion was necessary. The blood loss was 500 mL (range 100-1100), with a 0% transfusion rate. Single-finger assistance improved the total operative time to 140 minutes (range 110-180; P = .007) and blood loss to 250 mL (range 200-350; P = .02). The specimen weight was 82 g (range 50-150). The indwelling catheters were removed after 6 days (range 3-15), and the patients returned to work after 13 days (range 8-17). After a median follow-up of 13 months (range 2-18), the patients had a median flow rate of 23 mL/s without any postvoid residual urine.

The results of our study have shown that preperitoneal robotic transvesical prostate adenomectomy is a feasible and reproducible procedure. Additional series with larger patient cohorts and prostate adenomas are needed.