LAPAROSCOPIC RADICAL PROSTATECTOMY: THE NERVE SPARING TECHIQUE
J. B. Mendes1, M. T. Tanaka1, O. E. H. Fugita3, E. F. Pacagnan1, E. Gomes4, M. R. S. S. B. Mendes1, A. S. Tanaka1, J. L. Amaro2
1Master Clínica, Cascavel, Brazil, 2Unesp Botucatu, Brazil, 3Unioeste, Cascavel, Brazil, 4Clinica Plena, Toledo, Brazil
Introduction: To improve de results of a radical open nerve sparing prostatectomy is a challenge for laparoscopic radical prostatectomy (LRP). Maybe, its minimal invasive aspects associated with optical magnified viewing, might help laparoscopy to achieve this.
Method: The patient is positioned at mild Trendelenburg and approached extraperitoneally using five port-sites. The endopelvic fascia is opened and a downward lateral prostate dissection is carried out laterally. The penis dorsal venous complex is double sutured with 3.0 Vicryl. In order to access the retrovesical space, the anterior bladder wall is opened at the bladder neck level and them its posterior aspect is incised to dissect both seminal vesicle. To perform a downward rectal prostate dissection, the Denonvillie,s fascia is opened and a carefull technique, using a small metallic clip to deal with small perforating blood vessels, is applied in order to perform this dissection, mainly at its posterior-lateral aspects, right close to the prostate during this dissection. After the prostate removal, a final inspection shows both lateral-posterior tissue bunches spared, delineating the prior prostate lodge. The surgery is conclude with a vesico-uretral anastomosis using 3-0 PDS running sutures with a slight modification of the vanVelthoven technique.
Result: This technique increases operation time by one more hour.
Conclusion: For Radical Prostatectomy, the laparoscopic nerve sparing technique seems to be promising, as far as better results on erectile function recovery and urinary continence is concerned.