The intrafascial nervesparing endoscopic extraperitoneal dadical prostatectomy (1. Filmpreis 2008)
Stolzenburg J.-U.1, Rabenalt R.1, Do H.M.1, Schwalenberg T.1, Liatsikos E.*2
1Universitätsklinikum Leipzig, AöR, Klinik und Poliklinik für Urologie, Leipzig, Germany, 2Universität Patras, Klinik für Urologie, Patras, Greece
Endoscopic extraperitoneal radical prostatectomy (EERPE) has become the standard surgical approach to organ-confined prostate cancer in our centre. In selected patients nerve sparing radical prostatectomy is performed with the aims of maintaining sexual function and promoting early recovery of continence after surgery, without compromising the final oncological outcome.
Based on anatomical studies and our experience with nerve-sparing EERPE we have further refined our technique. This DVD demonstrates our new approach, the intrafascial nerve-sparing EERPE, step by step and aims to demonstrate its feasibility and reproducibility. In contrast to the steps followed for “standard nsEERPE”, during an intrafascial nsEERPE the endopelvic fascia is not incised. Instead, starting from the bladder neck, the periprostatic fascia is sharply incised on each side ventrally, medial to the puboprostatic ligaments, to develop the plane directly on prostatic capsule. The same plane is developed posteriorly, without incision of Denonvilliers fascia. After dissection of the prostatic pedicles all nerves dorsolaterally and laterally are preserved using clips and cold scissors.
The main goal of this technique is to develop the right plane and finally detach the prostate, leaving intact all lateral enveloping periprostatic fascia (including the endopelvic fascia), the neurovascular structures within and puboprostatic ligaments as a continuous structure.