Progress in pelvic anatomy from the viewpoint of radical prostatectomy

Abstract

Abbreviations & AcronymsAbstract: The procedure of radical prostatectomy has changed rapidly since the introduction of laparoscopic and robotic surgery, which allows for clear, highly magnified visualization. The da Vinci surgical system enables three-dimensional visualization and makes use of instruments with seven degrees of freedom. Since its introduction, the use of robot-assisted radical prostatectomy has spread rapidly worldwide. However, adaptation to changes in surgical techniques using knowledge of classical pelvic anatomy has been difficult. In this report, we reviewed the progress in knowledge of pelvic anatomy, particularly regarding the cavernous nerves, prostatic fascia, Denonvilliers' fascia, endopelvic fascia, bladder neck and apex of the prostate, with regard to radical prostatectomy.

The rectovaginal septum: visible on magnetic resonance images of women with Mayer-Rokitansky-Küster-Hauser syndrome (Müllerian agenesis)

“…He could even provide histological evidence for the existence of a pubocervical fascia in women with vaginal agenesis [13]. In the surgical field of urology, Denonvilliers' facia is still a structure of importance [17–19]. Zhai et al describe the rectovaginal septum as a structure composed of anterior and posterior layers—to be specific, the Denonvilliers' fascia and the fascia proprium of the rectum [11].…”

Structural study of endopelvic fascia in prostates of different weights. Anatomic study applied to radical prostatectomy

“…The prostatic fascia is a multilayered connective tissue that comprises collagenous fibers, fat tissues, nerves and blood vessels. Laterally it fuses with the endopelvic fascia [12][13][14] .…”

“…Preservation of the fascia helps to protect the levator ani muscle, rhabdosphincter and pudendal nerve branches to the rhabdosphincter 3,5,15 . The current consensus, therefore, is that the neurovascular structures are located in the postero-lateral region of the prostate, at the confluence of Denonvilliers' fascia with the endopelvic and pararectal fascia [12][13][14] .…”

“…The parietal and visceral endopelvic fascia is fused on the lateral side of the prostate and bladder. In this fusion, the levator fascia approaches the prostate and then turns back laterally [12][13][14] . This fusion site is sometimes recognized as a whitish line and is called the arcus tendineus fascia pelvis.…”

“…An incision in the endopelvic fascia is necessary to confirm the presence of pre-rectal fat postero-lateral to the prostate in extrafascial dissection or non-nerve-sparing procedures 12 .…”