Anatomy of Autonomic Nerve Component in the Male Pelvis: the New Concept from a Perspective for Robotic Nerve Sparing Radical Prostatectomy

Overview

Journal World J Urol

Specialty Urology

Date 2006 Jun 8

PMID 16758247

Citations 14

Authors

Atsushi Takenaka

Robert A Leung

Masato Fujisawa

Ashutosh K Tewari

Affiliations

Soon will be listed here.

Abstract

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers. A video study of 205 surgeries was performed for establishing the anatomy relevant to robotic prostatectomy. From a practical standpoint, we could group the relevant neural tissue into three broad zones: (1) proximal neurovascular plate (PNP), (2) predominant neurovascular bundles (PNB), (3) accessory distal neural pathways (ANP). Autonomic ganglion cells existed widely not only in nerve components but also along the viscera. The critical areas of nerve sparing surgery were the distal end of PNP, the entire PNB, and the circumference of the apex. Interindividual differences of cell counts were evident in all sites. Based on these concepts, we established the Athermal Robotic Technique (ART) for nerve sparing prostatectomy. Surgical and oncological outcomes were not mature but feasible. These tri-zonal and ganglion cell concepts may be of benefit to new surgeons undertaking nerve-sparing robotic radical prostatectomy.

Citing Articles

Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?.

Kang S, Shim J, Onol F, Bhat K, Patel V Investig Clin Urol. 2020; 61(1):1-10.

PMID: 31942457 PMC: 6946819. DOI: 10.4111/icu.2020.61.1.1.

Visualization of peri-prostatic neurovascular fibers before and after radical prostatectomy by means of diffusion tensor imaging (DTI) with clinical correlations: preliminary report.

Siracusano S, Porcaro A, Tafuri A, Pirozzi M, Cybulski A, Shakir A J Robot Surg. 2019; 14(2):357-363.

PMID: 31280463 DOI: 10.1007/s11701-019-00998-z.

Intrafascial nerve-sparing radical prostatectomy improves patients' postoperative continence recovery and erectile function: A pooled analysis based on available literatures.

Wang X, Wu Y, Guo J, Chen H, Weng X, Liu X Medicine (Baltimore). 2018; 97(29):e11297.

PMID: 30024505 PMC: 6086530. DOI: 10.1097/MD.0000000000011297.

Site-dependent differences in the composite fibers of male pelvic plexus branches: an immunohistochemical analysis of donated elderly cadavers.

Muraoka K, Morizane S, Hieda K, Honda M, Sejima T, Murakami G BMC Urol. 2018; 18(1):47.

PMID: 29789007 PMC: 5964883. DOI: 10.1186/s12894-018-0369-9.

Evaluation of periprostatic neurovascular fibers before and after radical prostatectomy by means of 1.5 T MRI diffusion tensor imaging.

Paola V, Cybulski A, Belluardo S, Cavicchioli F, Manfredi R, Mucelli R Br J Radiol. 2018; 91(1085):20170318.

PMID: 29388808 PMC: 6190772. DOI: 10.1259/bjr.20170318.

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