Athermal bladder neck dissection during robot-assisted radical prostatectomy
Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontin...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Urologia
2014-06-01
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| Series: | International Brazilian Journal of Urology |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382014000300433&lng=en&tlng=en |
| _version_ | 1811234091181277184 |
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| author | Fabrizio Dal Moro |
| author_facet | Fabrizio Dal Moro |
| author_sort | Fabrizio Dal Moro |
| collection | DOAJ |
| description | Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN) serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at the prostato-vesical junction, contributing to earlier return of urinary continence. The purpose of this video is to show an anatomical athermal dissection of BN during RARP.Materials and Methods After incision of endopelvic fascia and anterior defatting, the morphology of prostate not only laterally, but also at the level of bladder-prostatic junction is well visualized. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of BN. A cold section of the preserved BN permits the complete preservation of integrity of this sphincteric structure.Results With this technique we preserve the longitudinal fibres of BN, allowing the sparing of the sphincteric mechanism of BN. The finding of a difficult athermal dissection of these plans may make you suspect the presence of an infiltration, suggesting to sacrifice BN in order to avoid a positive surgical margin. In our series no increase of PSM has been recorded using this technique.Conclusions This surgical technique preserving the natural BN mechanism appears to improve urinary continence, allowing at the same time an easy identification of a neoplastic infiltration. |
| first_indexed | 2024-04-12T11:30:50Z |
| format | Article |
| id | doaj.art-32d86a3294184d0aac0db23d44ee603e |
| institution | Directory Open Access Journal |
| issn | 1677-6119 |
| language | English |
| last_indexed | 2024-04-12T11:30:50Z |
| publishDate | 2014-06-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-32d86a3294184d0aac0db23d44ee603e2022-12-22T03:35:02ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-61192014-06-0140343343410.1590/S1677-5538.IBJU.2014.03.22S1677-55382014000300433Athermal bladder neck dissection during robot-assisted radical prostatectomyFabrizio Dal MoroIntroduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN) serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at the prostato-vesical junction, contributing to earlier return of urinary continence. The purpose of this video is to show an anatomical athermal dissection of BN during RARP.Materials and Methods After incision of endopelvic fascia and anterior defatting, the morphology of prostate not only laterally, but also at the level of bladder-prostatic junction is well visualized. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of BN. A cold section of the preserved BN permits the complete preservation of integrity of this sphincteric structure.Results With this technique we preserve the longitudinal fibres of BN, allowing the sparing of the sphincteric mechanism of BN. The finding of a difficult athermal dissection of these plans may make you suspect the presence of an infiltration, suggesting to sacrifice BN in order to avoid a positive surgical margin. In our series no increase of PSM has been recorded using this technique.Conclusions This surgical technique preserving the natural BN mechanism appears to improve urinary continence, allowing at the same time an easy identification of a neoplastic infiltration.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382014000300433&lng=en&tlng=en |
| spellingShingle | Fabrizio Dal Moro Athermal bladder neck dissection during robot-assisted radical prostatectomy International Brazilian Journal of Urology |
| title | Athermal bladder neck dissection during robot-assisted radical prostatectomy |
| title_full | Athermal bladder neck dissection during robot-assisted radical prostatectomy |
| title_fullStr | Athermal bladder neck dissection during robot-assisted radical prostatectomy |
| title_full_unstemmed | Athermal bladder neck dissection during robot-assisted radical prostatectomy |
| title_short | Athermal bladder neck dissection during robot-assisted radical prostatectomy |
| title_sort | athermal bladder neck dissection during robot assisted radical prostatectomy |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382014000300433&lng=en&tlng=en |
| work_keys_str_mv | AT fabriziodalmoro athermalbladderneckdissectionduringrobotassistedradicalprostatectomy |