Nerve-Sparing Endoscopic Extraperitoneal Radical Prostatectomy
Stolzenburg J.1, Do H.1*, Rabenalt R.1
1Universitätsklinikum Leipzig AöR, Urologische Klinik und Poliklinik, Leipzig
Objectives: Laparoscopic radical prostatectomy (LRPE) became the operative procedure of choice for patients with clinically localized prostate cancer in specialized urological centers. Despite many advantages, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal located prostate. The principal disadvantage of LRPE is therefore the potential intraperitoneal complications that may arise. The endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of LRPE. EERPE overcomes the disadvantages of transperitoneal surgery by remaining in a strictly extraperitoneal environment.
Material and Methods: Based on our experience with this procedure we developed a standardized nerve-sparing technique. This DVD shows the technique of nerve-sparing endoscopic extraperitoneal radical retropubic prostatectomy for treating localized prostate cancer step by step.
Results: The standardized steps of the procedure are the following: dissection of the extraperitoneal space and trocar placement, incision of the endopelvic fascia and division of the puboprostatic ligaments, ligation of the Santorini plexus, anterior bladder neck dissection, incision of the periprostatic fascia to mobilize the neurovascular bundles, lateral and posterior bladder neck dissection, division of the vasa deferentia, dissection of the seminal vesicles, incision of the posterior layer of Denonvillier's fascia, division of the prostatic pedicles with preservation of the neurovascular bundles, apical dissection, urethrovesical anastomosis (interrupted sutures), removing of the specimen via endobag.
Conclusions: Endoscopic Extraperitoneal Radical Prostatectomy (EERPE) is a further advancement of minimal invasive surgery as it overcomes the limitations of LRPE by the strictly extraperitoneal route of access combining the advantages of minimal invasive surgery with the advantages of an extraperitoneal procedure. After experience with more than 450 procedures, we introduce several technical modifications, improvements and refinements of the operative technique including a nerve-sparing, potency-preserving approach (nEERPE) in an effort to further improve this minimally invasive procedure.