August 2010 -- In European Urology, the official journal of the European Association of Urology, a new section will be published as of the September issue: Case Series of the month. This series is dedicated to publishing promising studies which have so far only preliminary results. The Case Series reports on no more than 10 patients and includes illustrative images. A Continuing Medical Education question with multiple choice answers is also included to enable readers to earn CME points.
The first case series is written by Antonio Galfano et al and entitled 'A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery'. Robot-assisted laparoscopic prostatectomy (RALP) was first performed in 2000 by Binder et al in Frankfurt, Germany and by Abbou et al in Creteil, France. Since then, RALP has been disseminated widely with continuous improvements in technique and knowledge of the surgical anatomy of the prostate.
Nevertheless, endopelvic fascia, neurovascular bundles, puboprostatic ligaments, eventual accessory pudendal arteries, and the Santorini plexus, all advocated to play a role in maintenance of potency and continence, remain at risk of damage using the robotic approach.
During the authors' learning curve for RALP they developed an idea on how to avoid all of these anatomic structures by passing through a posterior plane, the Douglas space. A three-arm da Vinci robot (Intuitive Surgical, Sunnyvale, CA, USA) was used.
The aim of the study is to demonstrate the feasibility of this new, purely intrafascial approach. The new 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, the first five patients undergoing the new approach for RALP are being presented. The results in three patients following two unsuccessful attempts are summarised. No perioperative major complication was recorded. The anatomic rationale for better results compared with traditional RALP is strong, but well-designed studies are needed to evaluate the advantages of this technique.
|Contact: Lindy Brouwer|
European Association of Urology