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A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery eulogo1

By: Antonio Galfanolowast , Assunta Ascione, Salvatore Grimaldi, Giovanni Petralia, Elena Strada and Aldo Massimo Bocciardi

European Urology, Volume 58 Issue 1, September 2010, Pages 457-461

Published online: 01 September 2010

Keywords: Prostate neoplasms, Prostate cancer, Radical prostatectomy, RALP, Da Vinci, Robot-assisted laparoscopic radical prostatectomy

Abstract Full Text Full Text PDF (680 KB)

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.

Keywords: Prostate neoplasms, Prostate cancer, Radical prostatectomy, RALP, Da Vinci, Robot-assisted laparoscopic radical prostatectomy.

Footnotes

Department of Urology, Niguarda Ca’ Granda Hospital, Milan, Italy

lowast Corresponding author. Department of Urology, Niguarda Ca’ Granda Hospital, Piazza dell’Ospedale Maggiore, 3, 20162 Milan, Italy. Tel. +39 02 6444 4833; Fax: +39 02 6444 4882.

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