PMC3339799_01
(a) Prominent median lobe of prostate noted on bladder neck transection during robotic-assisted radical prostatectomy. (b) Bladder stone retrieval using Endowrist ProGrasp  forceps while bladder neck held open with Endowrist Maryland forceps. (c) Multiple stones retrieved and placed in EndoCatch  Gold entrapment sac. (d) The bladder inspected for residual calculi - the mucosa appears trabeculated and inflamed from chronic outlet obstruction
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Given the prominent median lobe of the prostate encountered [Figure 1a], posterior bladder neck transection was completed after visual identification of both ureteral orifices with the aid of intravenous indigo carmine. Hot shear  scissors on the right robotic arm was then exchanged for a robotic ProGrasp  forceps. Holding open the bladder neck with the left-sided Maryland forceps, the ProGrasp  forceps were used to manually retrieve the bladder stones one at a time [Figure 1b]. Sixteen stones were retrieved in total [Figure 1c]. The bladder was then inspected for residual stones using both graspers to manipulate the transected bladder neck, and bladder irrigation with normal saline performed repeatedly to ensure complete stone clearance [Figure 1d].