With an increasing life expectancy, more and more men will be at risk of developing prostate cancer in a larger prostate. Surgical treatment of these large glands is challenging due to impaired visualisation with a reduced overview of the surgical plane and limited working space combined with reduced options for intra-operative manipulation of these prostates. This in turn can result in prolonged operative times, increased blood loss, poor nerve sparing and apical dissection, and a higher chance of other complications. However, these larger prostates seem to be associated with a lower incidence of high grade tumors as well as a lower tumor volume and these men may therefore also be at a lower risk of positive margin and biochemical recurrence after radical prostatectomy. Prostate size does not seem to play a role in oncological outcomes, but in the recovery of continence and erectile function this is still controversial. This chapter will focus on the outcomes following robotic-assisted laparoscopic prostatectomy in large prostates, particularly those over 100 g, will present the challenges presented during surgery in these larger glands and hope to provide some advice on how to overcome them.

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doi.org/10.1007/978-3-319-64704-3_12, hdl.handle.net/1765/105066
Erasmus MC: University Medical Center Rotterdam

van der Meer, S., Kasivisvanathan, V., & Challacombe, B. (Ben). (2017). Robotic radical prostatectomy in the large prostate. In The Big Prostate (pp. 153–165). doi:10.1007/978-3-319-64704-3_12