Background: The growing prevalence of obesity, particularly morbid obesity (BMI > 40 kg/m²), presents unique challenges in surgical management. In robotic-assisted radical prostatectomy (RARP) for prostate cancer, morbid obesity is associated with longer operative times, increased blood loss, and complex nerve-sparing procedures. These challenges may impact functional and oncological outcomes, making it essential to understand how high BMI affects RARP results. However, data on outcomes for patients with morbid obesity remain limited. Methods: We retrospectively reviewed 14,444 patients who underwent RARP by a single surgeon from 2008 to 2023. A total of 183 patients with morbid obesity (BMI > 40 kg/m²) were matched 1:1 with 183 normal-weight patients (BMI 18.5–24.9 kg/m²) using propensity-score matching based on age, PSA levels, clinical staging, ISUP grade, comorbidities, and baseline urinary and sexual function scores. We compared perioperative variables, complications, and oncological and functional outcomes between groups. Results: Patients with morbid obesity had longer console times (median 90 vs. 75 min, p < 0.001) and higher rates of estimated blood loss over 100 mL (39% vs. 22%, p = 0.001). Full nerve-sparing was less frequent in this group (16.9% vs. 38.8%, p < 0.001), and postoperative lymphocele formation rates were higher (12.7% vs. 6.0%, p = 0.021). While patients with morbid obesity demonstrated a higher incidence of pT3a disease (34.4% vs. 20.2%, p = 0.015), no significant differences were observed in BCR and PSM (24% vs. 18%, p = 0.25) or functional outcomes, such as potency and urinary continence, at 12 and 24 months after operation. Conclusions: RARP in patients with morbid obesity is safe and feasible, with low rates of complications and no observed differences in functional and oncological outcomes compared to normal-weight patients. Further studies are needed to assess long-term outcomes in this growing patient population.

Background: Pelvic lymph node dissection (PLND) is recommended while performing robot-assisted radical prostatectomy (RARP) for patients with localized intermediate or high-risk prostate cancer. However, symptomatic lymphoceles can occur after surgery, adding significant morbidity to patients. Our objective is to describe a novel Peritoneal Bladder Flap Bunching technique (PBFB) to reduce the risk of clinically significant lymphoceles in patients undergoing RARP and PLND. Methods: We evaluated 2267 patients who underwent RARP with PLND, dividing them into two groups: Group 1, comprising 567 patients who had the peritoneal flap (PBFB), and Group 2, comprising 1700 patients without the flap; propensity score matching carried out at a 1:3 ratio. Variables analyzed included estimated blood loss (EBL), operative time, postoperative complications, lymphocele formation, and the development of symptomatic lymphocele. Results: The two groups exhibited similar preoperative characteristics after matching. There was no statistically significant difference in the occurrence of lymphoceles between the flap group and the non-flap group, with rates of 24% and 20.9%, respectively (p = 0.14). However, none of the patients in the flap group (0%) developed symptomatic lymphoceles, whereas 2.2% of patients in the non-flap group experienced symptomatic lymphoceles (p = 0.01). Conclusion: We have demonstrated a modified technique for a peritoneal flap (PBFB) with the initial elimination of postoperative symptomatic lymphoceles and promising short-term outcomes.