Introduction and Objectives
The aim is to stress important anatomic landmarks and functional importance of these in a model of patient who had laparoscopic radical prostatectomy.
Material and Methods
Extraperitoneal nerve-sparing radical prostatectomy might be summarized into seven steps. Terminologia Anatomica and its functional importance were based on this classification. Significant anatomic landmarks were pointed out. Steps were;
- 1.Anterior abdominal wall and trocar positioning,
- 2.Fascia pelvis (endopelvic fascia) and incision of fascia pelvis,
- 3.Detachment of puboprostatic complex,
- 4.Urethral sphincteric complex, preservation of continence unit,
- 5.Anatomic apical dissection of prostate and urethra,
- 6.Fascia rectoprostatica (Denonvillier fascia), dissection of posterior part of prostate,
- 7.Neurovascular bundle, pedicle dissection, pelvic plexus related with erectile function preservation.
Results
In steps, important anatomic landmarks were:
- 1.linea alba, linea arcuata (arcuate line), linea semilunaris, umbilicus, spina iliaca anterior superior (anterior superior iliac spine), m. rectus abdominis (rectus abdominis muscle), a. and v. epigastrica superior – inferior (superior and inferior epigastric artery and vein), n. subcostalis (subcostal nerve);
- 2.fascia pelvis parietalis (endopelvic fascia), arcus tendineus, fascia obturatoria internus (internal obturator fascia), fascia iliaca (iliac fascia);
- 3.ligamentum puboprostaticum (puboprostatic ligament), plexus venosus dorsalis (Santorini plexus), fibromuscular and soft tissue, symphysis pubis (pubic symphysis), detrusor apron, vena dorsalis profunda penis (deep dorsal vein of penis), plexus venosus vesicalis, plexus venosus prostaticus;
- 4.M. sphincter urethrae internus-externus (external-internal urethral sphincter);
- 5.plexus venosus dorsalis (avoid injury), M. levator ani, neurovascular bundle (avoid injury), smooth muscle of the urethra;
- 6.fascia rectoprostatica, posterior part of prostate, vesicula seminalis, perirectal fatty tissue;
- 7.A. vesicalis inferior (inferior vesical artery), N. cavernosus penis (cavernous nerve of penis), a. and v. capsularis, pelvic plexus, lateral pelvic fascia, levator fascia (interfascial dissection), fascia periprostatica (periprostatic fascia) (intrafascial dissection), capsula prostatica (prostatic capsule).
Conclusions
Focusing on anatomy of laparoscopic radical prostatectomy with suitable terminology might be the gold standard way of learning for this difficult surgical technique.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
