*5.2.2 Male (cysto-prostatectomy)*

When performing a lateral approach to the prostate the dissection of the lateral surface of the bladder starts on the right side, down dissection goes proximal to the prostatic pedicle following along the prostatic capsule and the seminal vesicle is identify [19]. The dissection starts lateral to the umbilical ligament, an incision is perform to the peritoneum until the finding of the ureter (**Figure 7**).

Following the ligament and medial will find the right ureter, while dissecting the perineotomy starts a little bit medial but not full open, just to continuo down and to expose the Vas Deferens and the Seminal Vesicle. The ureter is transected and clipped (**Figure 8**).

#### **Figure 7.**

*Peritoneum incision and umbilical identification and transection.*

**Figure 8.** *Right ureter and half perineotomy.*

**Figure 9.** *Right lateral prostatic dissection.*

The medial and ventral surfaces of the Seminal vesicle is transect, preserving the middle part and tip avoiding parasympathetic fibers damage in selected cases. The prostate vesicular angle is follow laterally to the apex [20–23] (**Figure 9**).

The same steps are replicated for the left side, starting with incision in the peritoneum lateral to the umbilical ligament, then ureter identification and transection. The lateral pedicles form bladder and prostate are identified and the seminal vesicle and vas are transected. The lateral face of the prostate is follow till the apex, and the Denonvillier's fascia is released (**Figure 10**).

Ligaments and endopelvic fascia are preserved, Santorini plexus is push up without any stich, the urethra is clip transected with the maximum length possible. The specimen is placed in an Endobag (**Figure 11**).
