Radical Prostatectomy

Abstract

I perform the classic Montsouris technique. I simply believe that this allows one to preserve the neurovascular bundle along its entire course with minimal traction in an antegrade direction. What I mean specifically is, during the Montsouris technique the seminal vesicles are dissected at the onset of the operation. By approaching the seminal vesicles in this fashion, one is able to virtually pluck the seminal vesicles out of their vascular bed and tease the nerve bundles off the seminal vesicles with excellent visualization, as there is minimal bleeding early in the operation. This is in contrast to the extraperitoneal approach, where the seminal vesicles are approached late in the dissection after the bladder neck has been divided. With this approach, one has to reach down and dig the seminal vesicles out from a hole with limited visualization, due to bleeding as well as urine in the field; and I am convinced that this is likely to result in more traction on the nerve bundles.