Radical laparoscopic prostatectomy is a challenging procedure that has largely been replaced by robotic surgeries. The technical difficulty of a considerable number of maneuvers and a technically challenging vesicourethral anastomosis near the end make it one of the most advanced laparoscopic surgeries in Urology. The use of articulated devices, particularly if robotic, is quite attractive and can assist the surgeon in overcoming these difficulties, resulting in better outcomes.

This video aimed to demonstrate the first Iberian use of the Dex Surgical® robotic forceps in Urology and provide a step-by-step example of radical laparoscopic prostatectomy. A 49-year-old patient with an initial PSA of 21 ng/ml, prostate biopsy revealing Prostate Adenocarcinoma Gleason Score 4+3, no imaging evidence of metastasis (CT TAP + whole body cintigram) and severe obstructive symptoms with Qmax of 7 ml/s (uroflowmetry) underwent laparoscopic radical prostatectomy using the Dex Surgical® robotic forceps and a barbed suture 2/0 two needles 5/8 (Darvin loc) for the anastomosis.

The surgery lasted 130 minutes, estimated blood loss was 145 ml, and the patient was discharged from the hospital within 48 hours and had the catheter removed on the 6th day. The articulated scissors were used during tissue dissection and removal of the prostate, and the articulated needle holder was used during the vesicourethral anastomosis.

There are several articulated forceps on the market currently, with the Dex Surgical® robotic forceps being the only ones that are robotized, giving them an increased range of angles and movements. The first use of these forceps in Urology in the Iberian Peninsula allowed us to verify their theoretical advantages in practice. The authors highlight that some of the more complex and delicate maneuvers are only possible with articulated movements, including dissection of the lateral capsule, dissection of the Denonvilliers fascia in large prostates, dissection of the posterior wings of the prostatic apex, and suturing between 5 and 7 o'clock and between 11 and 1 o'clock. The authors also emphasize the ease of returning to classic laparoscopic techniques, which allows for a gradual introduction of these devices without significantly affecting surgical times during the learning curve. In a socioeconomic context where the availability of robotic surgery is limited, the authors believe that the use of robotic/articulated forceps represents an increase in quality compared to classical laparoscopic surgery.