Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical prostatectomy is a standard treatment for localized prostate cancer.
• Nerve-sparing techniques aim to preserve erectile function.
• Endoscopic extraperitoneal radical prostatectomy (nsEERPE) offers minimally invasive advantages.

Purpose of the Study:

• To present a modified nerve-sparing endoscopic extraperitoneal radical prostatectomy (nsEERPE) technique.
• To detail the intrafascial dissection approach preserving key anatomical structures.
• To evaluate the feasibility and initial outcomes of the modified technique.

Main Methods:

• A modified nsEERPE technique involving intrafascial dissection was performed in 50 consecutive patients.
• The technique focuses on preserving the puboprostatic ligaments, endopelvic fascia, periprostatic fascia, and neurovascular bundles.
• An anterior approach to the periprostatic fascia was utilized for dissection.

Main Results:

• The mean operative time was 131 minutes (range 75-165 minutes).
• The mean catheterization duration was 5.4 days (range 5-14 days).
• The intrafascial dissection was successfully applied in all cases.

Conclusions:

• The intrafascial nsEERPE represents a modification of the standard nsEERPE technique.
• The anterior approach facilitates less traumatic dissection, theoretically preserving neurovascular bundle integrity.
• This modified technique shows promising results for nerve-sparing radical prostatectomy.