Editorial Comment: Maximal anatomic bladder neck preservation at the prostatic origin (MANO) in robotic radical prostatectomy: does prostate size matter?

Deerush Kannan Sakthivel¹, Pushan Prabhakar², Mohamed Javid Raja Iyub², Manuel Ozambela Jr², Murugesan Manoharan²

¹ Department of Urology, Baptist Health South Florida, Miami, USA; ² Department of Urology, Baptist Health South Florida, Miami, USA

J Robot Surg. 2025 Oct 22;19(1):707.

DOI: 10.1007/s11701-025-02880-7 | ACCESS: 41125940

COMMENT

IRobotic surgery has revolutionized the surgical treatment of prostate cancer, resulting in better outcomes and faster recovery (¹–⁴). One of the most important aspects for the technical refinement of this surgical procedure is knowledge of pelvic anatomy. In tis paper of Sakthivel and collegues (⁵) we can observe the importance of the anatomy specially in large prostates. The authors described the maximal anatomic bladder neck preservation at the prostatic origin (MANO) technique, designed to enable safe circumferential dissection at the true bladder neck origin irrespective of gland size and concluded that larger prostates were associated with older age and higher preoperative, mean operative time increased with gland size and hospital stay was longer for > 50 cc prostates. The authros shows that the MANO technique enables safe bladder neck preservation across all prostate sizes. Despite increased operative complexity in larger glands, functional and oncological outcomes remain equivalent. This approach may standardize bladder neck management in RALP and support improved continence recovery irrespective of prostate volume. We congratulate the authors for the interesting paper.

Data Availability

Uninformed

REFERENCES

• ¹ Moschovas MC, Jaber A, Saikali S, Sandri M, Bhat S, Rogers T, Gamal A, Loy D, Patel E, Reddy S, Sighinolfi MC, Rocco B, Harvey T, Ficarra V, Patel V. Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening. Int Braz J Urol. 2024 Jan-Feb;50(1):65-79. doi: 10.1590/S1677-5538.IBJU.2023.0530.
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• ² Jiao RD, Wang Z, Kong XG, Tang SY, Xia D, Wu ZJ, Liu JC, Liu LH. Clinical Outcomes and Cost-effectiveness between the Sentire® and da Vinci® systems in Robot-assisted Radical Prostatectomy. Int Braz J Urol. 2025 Jul-Aug;51(4):e20240706. doi: 10.1590/S1677-5538.IBJU.2024.0706.
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• ³ Gamal A, Moschovas MC, Saikali S, Reddy S, Ozawa Y, Sharma R, Kunta A, Rogers T, Patel V. Comparing the Technological and Intraoperative Performances of Da Vinci xi and DaVinci 5 Robotic Platforms in Patients Undergoing Robotic-Assisted Radical Prostatectomy. Int Braz J Urol. 2025 Jan-Feb;51(1):e20240569. doi: 10.1590/S1677-5538.IBJU.2024.0569.
  » https://doi.org/10.1590/S1677-5538.IBJU.2024.0569
• ⁴ Pires RDS, Pereira CWA, Favorito LA. Is the learning curve of the urology resident for conventional radical prostatectomy similar to that of staff initiating robot-assisted radical prostatectomy? Int Braz J Urol. 2024 May-Jun;50(3):335-345. doi: 10.1590/S1677-5538.IBJU.2024.9909.
  » https://doi.org/10.1590/S1677-5538.IBJU.2024.9909
• ⁵ Sakthivel DK, Prabhakar P, Iyub MJR, Ozambela M Jr, Manoharan M. Maximal anatomic bladder neck preservation at the prostatic origin (MANO) in robotic radical prostatectomy: does prostate size matter? J Robot Surg. 2025 Oct 22;19(1):707. doi: 10.1007/s11701-025-02880-7.
  » https://doi.org/10.1007/s11701-025-02880-7

Edited by

• Editor in Chief
  Luciano Alves Favorito

• Associate Editor
  Luciano Alves Favorito

Publication Dates

• Publication in this collection
  11 May 2026
• Date of issue
  May-Jun 2026

History

• Received
  10 Feb 2026
• Accepted
  05 Mar 2026
• Published
  10 Mar 2026