A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery

Abstract Robot-assisted laparoscopic prostatectomy (RALP) has been disseminated widely, changing the knowledge of surgical anatomy of the prostate. The aim of our study is to demonstrate the feasibility of a new, purely intrafascial approach. The Bocciardi approach for RALP passes through the Dougla...

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Bibliographic Details
Published in:European urology 2010-09, Vol.58 (3), p.457-461
Main Authors: Galfano, Antonio, Ascione, Assunta, Grimaldi, Salvatore, Petralia, Giovanni, Strada, Elena, Bocciardi, Aldo Massimo
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Da Vinci
Feasibility Studies
Gynecology. Andrology. Obstetrics
Humans
Laparoscopy
Male
Male genital diseases
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Prostate cancer
Prostate neoplasms
Prostatectomy - methods
Prostatic Neoplasms - surgery
Radical prostatectomy
RALP
Robot-assisted laparoscopic radical prostatectomy
Robotics
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
Urology
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Summary:Abstract Robot-assisted laparoscopic prostatectomy (RALP) has been disseminated widely, changing the knowledge of surgical anatomy of the prostate. The aim of our study is to demonstrate the feasibility of a new, purely intrafascial approach. The Bocciardi approach for RALP passes through the Douglas space, following a completely intrafascial plane without any dissection of the anterior compartment, which contains neurovascular bundles, Aphrodite’s veil, endopelvic fascia, the Santorini plexus, pubourethral ligaments, and all of the structures thought to play a role in maintenance of continence and potency. In this case series, we present our first five patients undergoing the Bocciardi approach for RALP. We report the results of our technique in three patients following two unsuccessful attempts. No perioperative major complication was recorded. Pathologic stage was pT2c in two patients and pT2a in one patient, with no positive surgical margin. The day after removing the catheter, two of the three patients reported use of a single, small safety pad, and one patient was discharged without any pad. One patient reported an erection the day after removing the catheter. The anatomic rationale for better results compared with traditional RALP is strong, but well-designed studies are needed to evaluate the advantages of our technique.
ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2010.06.008