World Journal of Urology

, Volume 24, Issue 2, pp 136–143

Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy

  • Atsushi Takenaka
  • Robert A. Leung
  • Masato Fujisawa
  • Ashutosh K. Tewari
Topic Paper

DOI: 10.1007/s00345-006-0102-2

Cite this article as:
Takenaka, A., Leung, R.A., Fujisawa, M. et al. World J Urol (2006) 24: 136. doi:10.1007/s00345-006-0102-2
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Abstract

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers. A video study of 205 surgeries was performed for establishing the anatomy relevant to robotic prostatectomy. From a practical standpoint, we could group the relevant neural tissue into three broad zones: (1) proximal neurovascular plate (PNP), (2) predominant neurovascular bundles (PNB), (3) accessory distal neural pathways (ANP). Autonomic ganglion cells existed widely not only in nerve components but also along the viscera. The critical areas of nerve sparing surgery were the distal end of PNP, the entire PNB, and the circumference of the apex. Interindividual differences of cell counts were evident in all sites. Based on these concepts, we established the Athermal Robotic Technique (ART) for nerve sparing prostatectomy. Surgical and oncological outcomes were not mature but feasible. These tri-zonal and ganglion cell concepts may be of benefit to new surgeons undertaking nerve-sparing robotic radical prostatectomy.

Keywords

Neural anatomy Autonomic nerve Robotic prostatectomy Athermal technique Nerve sparing 

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Atsushi Takenaka
    • 2
  • Robert A. Leung
    • 1
  • Masato Fujisawa
    • 2
  • Ashutosh K. Tewari
    • 1
  1. 1.Department of UrologyNew York-Presbyterian Hospital, Weill Cornell Medical CenterNew YorkUSA
  2. 2.Division of Urology, Department of Organs TherapeuticsKobe University Graduate School of MedicineKobeJapan

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