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Review
. 2022 Feb 22:8:825183.
doi: 10.3389/fsurg.2021.825183. eCollection 2021.

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

Benedikt Hoeh  1   2 , Mike Wenzel  1 , Lukas Hohenhorst  2   3 , Jens Köllermann  4 , Markus Graefen  3 , Alexander Haese  3 , Derya Tilki  3   5   6 , Jochen Walz  7 , Marina Kosiba  1 , Andreas Becker  1 , Severine Banek  1 , Luis A Kluth  1 , Philipp Mandel  1 , Pierre I Karakiewicz  2 , Felix K H Chun  1 , Felix Preisser  1
Affiliations
Review

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

Benedikt Hoeh et al. Front Surg. .

Abstract

Context: Meticulous knowledge about the anatomy of the prostate and surrounding tissue represents a crucial and mandatory requirement during radical prostatectomy for reliable oncological and excellent replicable, functional outcomes. Since its introduction two decades ago, robotic-assisted laparoscopic radical prostatectomy (RALP) has evolved to become the predominant surgical approach in many industrialized countries.

Objective: To provide and highlight currently available literature regarding prostate anatomy and to help in improving oncological and functional outcomes in RALP.

Methods/evidence acquiring: PubMed database was searched using the following keywords: "robotic-assisted radical prostatectomy," "anatomy," "neurovascular bundle," "nerve," "periprostatic fascia," "pelvis," "sphincter," "urethra," "urinary incontinence," and "erectile dysfunction." Relevant articles and book chapters were critically reviewed and if eligible, they were included in this review.

Results: New evidence in regards to prostatic anatomy and surgical approaches in RALP has been reported in recent years. Besides detailed anatomical studies investigating the meticulous structure of the fascial structures surrounding the prostate and neurovascular bundle preservation, debate about the optimal RALP approach is still ongoing, inspired by recent publications presenting promising functional outcomes following modifications in surgical approaches.

Conclusions: This review provides a detailed overview of the current knowledge of prostate anatomy, its surrounding tissue, and its influence on key surgical step development for RALP.

Keywords: RALP; anatomy; functional outcome; prostate cancer; robotic-assisted.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of the topographic location of the prostate and its correlation to the urinary bladder, neurovascular bundle and urinary sphincter complex.
Figure 2
Figure 2
Axial section of the prostate and its adjactent tissue at midprostate.
Figure 3
Figure 3
Enlarged axial section of the prostate and its adjactent tissue at midprostate illustrating dissection planes according to (A) Walz et al. (1, 2), (B) Montorsi et al. (15, 58), (C) Tewari et al. (59), and (D) Schatthof et al. (60).
See this image and copyright information in PMC

References

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