Dorsal venous complex ligation-free and parietal endopelvic fascia preserving in laparoscopic radical prostatectomy: A prospective study of single centre

Abstract

Objectives: This study aims to describe a novel dorsal venous complex (DVC) ligation-free and parietal endopelvic fascia preserving technique for laparoscopic radical prostatectomy and to evaluate its post-operative outcomes.

Methods: From April 2020 to May 2021, a total of 125 patients with localized prostate cancer received laparoscopic radical prostatectomy by a single surgeon. In the procedure, a novel technique of DVC ligation-free and parietal endopelvic fascia preserving was used. Preoperative characteristics of patients and perioperative results were recorded. In this study, continence was defined as zero to one pad per day. Oncological outcomes were evaluated based on positive surgical margin.

Results: Five patients required a blood transfusion. Mean post-operative hospital stay was 3.9 days (2-5), and the catheter could be removed on post-operative day 7 to 9. Final pathologic evaluations were 87 stage pT2, 22 stage pT3a, and 7 pT3b, 9 stage pT4, respectively. The positive surgical margin rate was 10.4% in total. Ninety-three patients (74.4%) returned to urinary continence 2 months post-operatively, and 11 patients (11/125) developed biochemical recurrence 6 months post-operatively.

Conclusions: The DVC ligation-free and parietal endopelvic fascia preserving technique provides early recovery from incontinence without adversely affecting the oncological outcome.

Keywords: dorsal venous complex; endopelvic fascia; parietal; prostate cancer; radical prostatectomy.

FIGURE 1

(A) The parietal and visceral components of the endopelvic fascia are bluntly separated along the fascial tendinous arch of the pelvis where those two parts fused so as to preserve the parietal endopelvic fascia (showing with the white dashed line). (B) The bluntly separated parietal and visceral components of the endopelvic fascia. The white dashed lines show the detached fascial tendinous arch of the pelvis.

FIGURE 2

(A) The left prostatic pedicle is divided with an automatic excision anastomosis device after Denonvilliers' fascia incision and posterior prostatic surface dissection. The white dashed lines show the detached ascial tendinous arch of the pelvis. (B) The divided left prostatic pedicle (blue arrows).

FIGURE 3

The detrusor apron is transected where the puboprostatic ligaments fusion with the detrusor apron, or near the base of the prostate with a Harmonic, and the periprostatic fascia, including the DVC, detrusor apron and puboprostatic ligaments were dissected from the ventral surface of the prostate below the plane of the vessel without substantial bleeding.