Purpose: Nerve-sparing robot-assisted radical prostatectomy is technically challenging in patients with large prostates due to distorted anatomy and limited working space. Through a surgical video demonstration, we describe our step-by-step application of a retrograde nerve-sparing technique in a patient with a large prostate. Surgical
Surgical Methods: A 68-year-old man with clinical T1c prostate cancer and a 124 cc prostate underwent conventional robot-assisted radical prostatectomy using a six-port transperitoneal approach. Retrograde nerve sparing was performed bilaterally. After incising the Denonvilliers’ fascia, an avascular plane was developed posteriorly to release the posterior neurovascular bundle from 5 to 1 and 7 to 11 o’clock positions on the right and left sides, respectively. During posterior dissection, the camera was toggled between 30° down and 30° up to obtain a clear visualization of the narrow posterior plane. Subsequently, the endopelvic fascia was incised at the base of the prostate until the posterior neurovascular plane was reached. The bilateral pedicles were then secured using Hem-o-lok clips.
Results: The total operative time was 80 minutes, with an estimated blood loss of 100 mL. The patient was discharged the following morning without any perioperative complications. The Foley catheter was removed on postoperative day 5 following the confirmation of no leakage at the anastomosis site.
Conclusions: Retrograde nerve-sparing approach with the toggling technique facilitates early neurovascular bundle release and can reduce the risk of traction and thermal injury, even in a restricted workspace. This approach allows for precise dissection and can contribute to improved functional outcomes while maintaining oncologic safety in anatomically challenging cases.

Purpose: Robot-assisted radical cystectomy (RARC) provides oncologic safety with potential for improved functional outcomes. However, urinary continence and sexual function remain underreported, especially in female patients. Surgical
Surgical Methods: This video presents surgical techniques for improving functional recovery after RARC with intracorporeal neobladder. In male patients, athermal retrograde nerve-sparing using 30° lens toggling, minimal apical dissection, and layered posterior reconstruction supported early continence and erectile function. In female patients, lateral-to-medial nerve preservation, endopelvic fascia sparing, round ligament suspension, and transverse vaginal cuff closure helped maintain continence and sexual function.
Results: The application of these tailored, sex-specific techniques was associated with favorable early functional outcomes, including urinary continence and sexual function recovery.
Conclusions: These tailored, sex-specific strategies demonstrate that meticulous techniques can improve quality of life in bladder cancer survivors.

Purpose: Robotic-assisted radical prostatectomy (RARP) continues to advance with the intro duction of single-port (SP) platforms and extraperitoneal approaches. This report outlines our initial experience with single-port extraperitoneal RARP (SP-EP RARP), employing limited apical dissection in a patient with a challenging abdominal history. Surgical
Surgical Methods: The surgical method largely mirrors traditional multiport techniques while utilizing the SP system’s benefits—less invasiveness, simplified specimen retrieval, and enhanced ergonomics in restricted operative fields. Our technique prioritizes athermic tissue handling, deliberate camera movements, interfascial nerve-sparing strategies, and restrained apical dissection to support early continence restoration.
Results: This case demonstrates the practicality and safety of SP-EP RARP in technically demanding scenarios, offering procedural insights to enhance results.
Conclusions: This method may provide a safe and consistent template for institutions adopting SP technology while ensuring oncologic safety and preservation of function.

Purpose: Vesicovaginal fistula (VVF) is a distressing complication that often occurs after gynecologic surgery, especially hysterectomy. Although surgical repair is the mainstay of treatment, traditional approaches may be challenging in patients with severe pelvic adhesions. We report a case of a successful VVF repair using a single-port robotic system via a pneumovesical approach, avoiding the peritoneal cavity. Surgical
Surgical Methods: A 57-year-old woman developed continuous urinary leakage 6 months after robotic hysterectomy. Cystoscopy and magnetic resonance imaging confirmed a 7-mm VVF at the bladder trigone. Due to extensive previous surgical adhesions, a transvesical approach was selected. The fistula tract was precisely dissected and closed with barbed sutures under robotic visualization.
Results: The operation duration was 100 minutes with minimal blood loss. The patient recovered uneventfully, with complete resolution of symptoms at 3 months.
Conclusions: This case demonstrates that single-port robotic pneumovesical repair is a safe and effective alternative for select VVF cases, providing minimal invasiveness and rapid recovery.