Application of tunnel-type separation pelvic plexus and neurovascular bundle in laparoscopic radical resection of prostate cancer

Abstract

Objective To summarize the experiences and evaluate the urinary continence of a novel tunnel technique via posterior approach for laparoscopic radical prostatectomy with pelvic nerve plexus and neuro vascular bundle being isolated. Methods Six patients admitted to YangDong Hospital of YangJiang between March 2015 and September 2016 were diagnosed with localized prostate cancer (stage T2c or lower). The mean level of prostate specific antigen (PSA) was 12.3 ng/ml. All patients underwent intrafascial radical prostatectomy. After the prostate was isolated from the rectum, the prostate and seminal vesicle were lifted. The pelvic nerve plexus and neurovascular bundle space were isolated using the tunnel technique. The space between the free prostate and rectum was filled up with gauze. The bladder neck was incised and the posterior wall was penetrated via the anterior approach, and the space was filled up with gauze. A tunnel was created on the frontal and dorsal sides of bilateral neurovascular bundles of the prostate. The suspension tissues between the pelvic cavity and rectum were free. The neurovascular bundle was changed from the tubular shape to layer shape. The apex of the prostate was cut off, and the forcep and the neurovascular bundle was protected. Results Intraoperative hemorrhage volume was 100-600 ml, 360 ml on average. The catheter was removed on the 21st day postoperatively. Postoperative hospital stay was 22-30 days, 26 days on average. Postoperative pathological examination of the incisional margin yielded negative results, which were diagnosed as prostate cancer. At 4 weeks postoperative, the mean serum level of PSA was 0.5 ng/ml. The duration of follow-up ranged from 1 to 16 months, 7 months on average. For all patients, the urinary continence was restored within 1 week after catheter removal. The daily use of urine diaper was ≤ 1 piece. Conclusion For patients with early tumor staging, posterior approach combined with anterior approach technique can be utilized to isolate the pelvic nerve plexus, neurovascular bundle, change the mass-shape tissues into layered tissues and preserve the nerve and benign fascial tissues as possible. Intrafascial radical prostatectomy can improve postoperative urinary continence. Key words: Laparoscopy; Prostate cancer; Urinary incontinence