Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy

Abstract

Radical prostatectomy (RP) became a first choice of treatment for prostate cancer after the advance in nerve-sparing techniques. However, the difficult technical details still involved in nerve-sparing RP (nsRP) can invite unwanted complications. Therefore, learning to recognize key anatomical features of the prostate and its surrounding structures is crucial to further improve RP efficacy. Although the anatomical relation between the pelvic nerves and pelvic fascias is still under investigation, this paper characterizes the periprostatic fascias in order to define a novel fascial-sparing approach to RP (fsRP), which will help spare neurovascular bundles. In uroanatomic perspective, it can be stated that nsRP is a functional identification of the surgical technique while fsRP is an anatomic identification as well. The functional and oncological outcomes related to this novel fsRP are also reviewed.

The novel laparoscopic training 3D model in urology with surgical anatomic remarks: Fresh-frozen cadaveric tissue

“…We should stress the importance of fascia-sparing radical prostatectomy (prostate in-out phenomen) as anatomic identification of nerve-sparing technique during the cadaveric training session, so as to show anatomic continuation of the pelvic, and prostatic fascial layers at the anterior, lateral and posterior aspects of the prostate. [21] Anatomic laparoscopic cystectomy and bilateral extended pelvic lymph node dissection For radical cystectomy, an anatomic dissection approach that follows the course of natural avascular plane is used. There are a few important anatomic landmarks, which should be identified for successful and bloodless operation.…”

Current view on nerve-sparing radical prostatectomy

“…Основными ориентирами при сохранении СНП являются фасции, окружающие предстательную железу. Технический прогресс (роботическая хирургия, трехмерное лапароскопическое оборудование) способствует лучшей интраоперационной визуализации и дифференцировке анатомических структур, что позволяет сохранять фасциальные слои во время нервосберегающей РПЭ [36]. Необходимо помнить, что сохранение СНП -технически сложный и многоступенчатый этап РПЭ, точно воспроизводить который на постоянной основе не представляется возможным вследствие существенных индивидуальных особенностей анатомии у различных пациентов.…”