57 Preservation of the lateral prostatic fascia during extraperitoneal laparoscopic nerve‐sparing prostatectomy

Abstract

Introduction: Recent evidence suggests that cavernous nerves run within layers of the lateral prostatic fascia. It has been proposed that a nerve sparing technique should therefore include preservation of this fascial layer in addition to the main bulk of the neurovascular bundle posterolateral to the prostate.Materials and methods: All patients on whom laparoscopic nerve‐sparing prostatectomy was performed (potent patients <70 years of age, PSA <10, primary Gleason score ≤3), underwent a ‘curtain dissection’ with preservation of the endopelvic and lateral prostatic fasciae. To avoid injury to the cavernosal nerves, no energy source was used and the tips of the seminal vesicles were preserved. We present an operative video demonstration of this technique.Results: This procedure can be performed without an increase in operative time or blood loss. Finer points of technique are displayed and explained.Conclusion: Preservation of the lateral prostatic fascia and the nerves running within its layers is feasible during nerve‐sparing laparoscopic radical prostatectomy. We have now performed this procedure on fifty patients, and future clinical follow‐up will assess whether this technique is associated with improved functional results.