Feasibility, Technique, and Principles of Tension- and Energy-Free Laparoscopic Radical Prostatectomy with Lateral Intrafascial Dissection of the Neurovascular Bundles with the Use of a High-Definition Optical Device

摘要

Radical retropubic prostatectomy (RRP) with nerve-sparing technique is based on the finding that cavernosal nerves, which are responsible for ejaculation, continence, and erectile function, pass around the bladder neck, the proximal part of the prostate, and the seminal vesicles directly to the apex caudally. The main objectives of RRP for clinically localized prostate cancer are oncologic clearance coupled with good functional outcomes for urinary continence and erectile function.Open RRP is still considered the gold standard. Furthermore, as more prostate cancers are detected at a younger age, patients expect a high level of functional outcome after surgical therapy. All RRPs are performed with either an an-terograde, retrograde, or a combined approach. In our opinion, the Huland and Studer technique is one of the best technical improvements during the last decade for RRP to preserve the neurovascular bundles (NVBs). Graefen and associates developed a combined anterograde-retrograde technique with a lateral approach to the NVB using a "peanut" sponge stick to push the bundle laterally and downward. With this technique, we acquired anatomic knowledge during laparoscopic and robot-assisted radical prostatectomy that we have applied in our daily practice to develop a tension-free and energy-free laparoscopic radical prostatectomy (LRP) with pure lateral intrafascial dissection of the NVB.