FRI-13 ANATOMY OF THE PROSTATE GLAND: EVOLVING UNDERSTANDING THROUGH LAPAROSCOPIC AND ROBOTIC UROLOGICAL SURGERY

Abstract

You have accessJournal of UrologyHistory of Urology: History Forum1 Apr 2017FRI-13 ANATOMY OF THE PROSTATE GLAND: EVOLVING UNDERSTANDING THROUGH LAPAROSCOPIC AND ROBOTIC UROLOGICAL SURGERY Peter Macneal, Sashi Kommu, Peter Rimington, and Harold Ellis Peter MacnealPeter Macneal More articles by this author , Sashi KommuSashi Kommu More articles by this author , Peter RimingtonPeter Rimington More articles by this author , and Harold EllisHarold Ellis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prostate gland was ill understood until the Renaissance when anatomists discovered the organ naming it “glandulous body.” In 1600 the French physician du Laurens introduced the name “prostatae” (Josef et al. 2009). Modern insight into the anatomy of the gland was supplemented by McNeal′s description of the zonal anatomy of the prostate (1981), and by rapid surgical advances in surgical technology. This is a review of recent developments in understanding of the prostate through robotic and laparoscopic urological surgery. METHODS A systematic literature search of PubMed, Medline, EMBASE, textbook chapters and historical archives was performed. RESULTS The introduction of laparoscopic radical prostatectomy (LRP) allowed assessment of the prostate and its anatomical relations with heighted magnification and new visual angles. Robotic surgical systems further enhanced visualisation, with superior magnification and additional three-dimensional views. New anatomical understanding led to modifications of surgical technique aiming to preserve continence and potency. In 2002, it was noted that important relationships existed between pelvic plexus ganglions and seminal vesicles. Further fine neural plexuses along the posterior and antero-lateral surface of the prostate were described based on cadaveric studies and laparoscopic and robotic views. Later on, the technique of nerve preservation in which a plane (deep to the Santorinis plexus) between the prostatic capsule and inner prostatic fascial layer is developed at its cranial extent was described (i.e. the Veil of Aphrodite). In 2003-2004, Lunacek et al. noted that the cavernosal nerves running along the prostate become displaced further anteriorly and spread, thus forming a concave shape (like a ′curtain′) of the neurovascular bundles. This led to the description of the modified ′curtain dissection′ in 2005. Recently interfascial dissection of the neurovascular bundles that is tension and cautery free was described. Recent advances on microdissection robotic platforms such as mini-balloon tissue dissection could render further understanding of the anatomy of the prostate (Kommu et al. J Endourol 2009). CONCLUSIONS Laparoscopic and robotic urological surgery has had a significant impact on our understanding of the prostate gland. This evolving understanding continues to redefine surgical practices towards optimised outcomes in oncological treatment, preservation of erectile function and maintenance of continence during radical prostatectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1064-e1065 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Peter Macneal More articles by this author Sashi Kommu More articles by this author Peter Rimington More articles by this author Harold Ellis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...