Rrp a decade of evolution

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Robotic Radical Prostatectomy: A decade of Evolution A . Mottrie G. Denaeyer, P. Schatteman, P. Carpentier, E. Fonteyne O.L.V. Clinic Aalst Belgium

Robot-assisted surgery indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Robot-assisted Prostatectomy Thanks to robotic surgery, more insights in microanatomy

Surgical Anatomy of the Prostate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Anatomy of the Prostate The Challenge ,[object Object],[object Object],[object Object]

Robot-assisted prostatectomy Sparing neurovascular bundles ,[object Object]

Robot-assisted prostatectomy Sparing neurovascular bundles Veil of Aphrodite ,[object Object]

Surgical Anatomy of the Prostate Proximal neurovascular plate Accessory neural pathways Predominant neurovascular bundle ,[object Object]

Surgical Anatomy of the Prostate Pelvic plexus HGN (sympathetic: hypogastric)) ,[object Object]

Surgical Anatomy of the Prostate ,[object Object]

Surgical Anatomy of the Prostate Posterior neurovascular plate ,[object Object]

R-A rad. prostatectomy technique : nerve-sparing LEVATOR ANI FASCIA LEVATOR ANI FASCIA LAT PROST FASCIA ,[object Object]

Fascial planes of dissection are numerous. What are the options ? Intra fascial (endo fascial) plane: fascia absent on the specimen (glandular tissue at margin !) Inter fascial (inter visceral fascial layers) plane: fascia partly present on the specimen (NVB sparing) Extra fascial plane: fascia entirely present on the specimen ,[object Object]

Surgical Anatomy of the Prostate I. Prostatic capsula ,[object Object]

Surgical Anatomy of the Prostate II. Inconsistent fascia on arteries & veins ,[object Object]

Surgical Anatomy of the Prostate III. Multilayer lateral prostatic fascia ,[object Object]

Surgical Anatomy of the Prostate IV. Levator fascia ,[object Object]

Surgical Anatomy of the Prostate Planes of dissection ,[object Object]

Surgical Anatomy of the Prostate Interfascial dissection

R-A rad. prostatectomy technique : nerve-sparing RP specimen Thin layer of visceral Fascia left on the prostatic Pseudo capsule ,[object Object]

Surgical Anatomy of the Prostate ,[object Object],[object Object],[object Object]

Robotics in urology Conclusion “ It’s like driving a limousine instead of a compact car. With both, you can do the same distance, but with a limousine, it’s easier, safer & more comfortable”

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