Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical prostatectomy is a primary treatment for prostate cancer.
• Preservation of neurovascular bundles is crucial for functional outcomes.
• Endoscopic extraperitoneal radical prostatectomy (EERPE) offers a minimally invasive approach.

Purpose of the Study:

• To present the refined intrafascial nerve-sparing EERPE (nsEERPE) technique.
• To evaluate the functional outcomes (continence and potency) and oncological results of nsEERPE.

Main Methods:

• The intrafascial technique involves dissection directly on the prostatic capsule.
• Preservation of the puboprostatic ligament, endopelvic fascia, periprostatic fascia, and neurovascular bundles.
• The procedure was performed on 150 patients indicated for nerve-sparing surgery.

Main Results:

• Mean operative time was 131 minutes; mean catheterization time was 5.9 days.
• Postoperative continence at 12 months was 94.3%; potency rates varied by age group (89.7% for 44-55 yrs, 81.1% for 56-65 yrs, 61.9% for >65 yrs).
• Positive surgical margins were 4.5% for pT2 and 29.4% for pT3 tumors.

Conclusions:

• Intrafascial nsEERPE allows prostate dissection with minimal trauma to surrounding structures.
• The technique preserves neurovascular bundles, potentially enhancing their viability.
• Results support the efficacy of intrafascial nsEERPE for functional and oncological outcomes.