Abstract
The development of the robotic platform and its use in radical urological procedures does not alter basic anatomical landmarks, but it does improve the vision and dexterity of the surgeons. Especially, the enhanced vision has assisted in identifying existing anatomy and preserving it more efficiently than with open surgery. Moreover, robotic surgeons have developed a standardized surgical procedure, in a stepwise fashion, that facilitates the flow of the procedure. These steps require additional caution in anatomical landmarks that may not usually be a part of the open approach. This chapter emphasizes on the basic anatomical knowledge of the male and female pelvis and peritoneal cavity, with specific attention to the basic steps of radical cystectomy and urinary diversion and their impact on the final outcomes of the procedure. The chapter also gives special attention to anatomical structures like nerves and vessels that may have an important role in the functional and oncological outcomes of the technique and for the risk of complications. We believe that the combination of these new findings along with the traditional anatomical landmarks will significantly increase the success of this complex and demanding urological procedure.
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References
Benninghoff D. Anatomy. 16th ed. München: Urban & Fischer Verlag; 2003.
Campbell MF, Wein AJ, Kavoussi LR. In: Wein AJ, Kavoussi LR, et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia: W.B. Saunders; 2007.
Netter FH. Atlas of human anatomy. 1st ed. Stuttgart: Thieme; 1997.
Otcenasek M, Baca V, Krofta L, Feyereisl J. Endopelvic fascia in women: shape and relation to parietal pelvic structures. Obstet Gynecol. 2008;111(3):622–30.
Shapiro E, Hartanto V, Perlman EJ, Tang R, Wang B, Lepor H. Morphometric analysis of pediatric and nonhyperplastic prostate glands: evidence that BPH is not a unique stromal process. Prostate. 1997;33(3):177–82.
Stolzenburg JU, Rabenalt R, Do M, Schwalenberg T, Winkler M, Dietel A, et al. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol. 2008;53(5):931–40.
Stolzenburg JU, Schwalenberg T, Horn LC, Neuhaus J, Constantinides C, Liatsikos EN. Anatomical landmarks of radical prostatecomy. Eur Urol. 2007;51(3):629–39.
van Ophoven A, Roth S. The anatomy and embryological origins of the fascia of Denonvilliers: a medico-historical debate. J Urol. 1997;157(1):3–9.
Wimpissinger TF, Tschabitscher M, Feichtinger H, Stackl W. Surgical anatomy of the puboprostatic complex with special reference to radical perineal prostatectomy. BJU Int. 2003;92(7):681–4.
Young HH. The radical cure of cancer of the prostate. Surg Gynecol Obstet. 1937;64:472–84.
Richards KA, Cohn JA, Large MC, Bales GT, Smith ND, Steinberg GD. The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. Urol Oncol. 2015;33(2):65.e1–8.
Ahmed YE, Hussein AA, May PR, Ahmad B, Ali T, Durrani A, et al. Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy. J Urol. 2017;198(3):567–74.
Richards KA, Steinberg GD. Perioperative outcomes in radical cystectomy: how to reduce morbidity? Curr Opin Urol. 2013;23(5):456–65.
Schilling D, Horstmann M, Nagele U, Sievert KD, Stenzl A. Cystectomy in women. BJU Int. 2008;102(9 Pt B):1289–95.
Colleselli K, Stenzl A, Eder R, Strasser H, Poisel S, Bartsch G. The female urethral sphincter: a morphological and topographical study. J Urol. 1998;160(1):49–54.
Sievert KD, Hennenlotter J, Laible I, Amend B, Schilling D, Anastasiadis A, et al. The periprostatic autonomic nerves–bundle or layer? Eur Urol. 2008;54(5):1109–16.
Baader B, Baader SL, Herrmann M, Stenzl A. Autonomic innervation of the female pelvis. Anatomic basis. Urologe A. 2004;43(2):133–40.
Baader B, Herrmann M. Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat. 2003;16(2):119–30.
Purves JT, Spruill L, Rovner E, Borisko E, McCants A, Mugo E, et al. A three dimensional nerve map of human bladder trigone. Neurourol Urodyn. 2017;36(4):1015–9.
Hutch JA. Saccule formation at the ureterovesical junction in smooth walled bladders. J Urol. 1961;86:390–9.
Fritsch H, Lienemann A, Brenner E, Ludwikowski B. Clinical anatomy of the pelvic floor. Adv Anat Embryol Cell Biol. 2004;175:III–IX, 1–64.
Nakajima F, Takenaka A, Uchiyama E, Hata F, Suzuki D, Murakami G. Macroscopic and histotopographic study of the deep transverse perineal muscle (musculus transversus perinei profundus) in elderly Japanese. Ann Anat. 2007;189(1):65–74.
Oelrich TM. The urethral sphincter muscle in the male. Am J Anat. 1980;158(2):229–46.
Oelrich TM. The striated urogenital sphincter muscle in the female. Anat Rec. 1983;205(2):223–32.
Shafik A, Sibai OE, Shafik AA, Shafik IA. A novel concept for the surgical anatomy of the perineal body. Dis Colon Rectum. 2007;50(12):2120–5.
Stein TA, DeLancey JO. Structure of the perineal membrane in females: gross and microscopic anatomy. Obstet Gynecol. 2008;111(3):686–93.
Wallner C, Dabhoiwala NF, Deruiter MC, Lamers WH. The anatomical components of urinary continence. Eur Urol. 2008;
Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9.
Strasser H, Ninkovic M, Hess M, Bartsch G, Stenzl A. Anatomic and functional studies of the male and female urethral sphincter. World J Urol. 2000;18(5):324–9.
Smith JA Jr, Whitmore WF Jr. Regional lymph node metastasis from bladder cancer. J Urol. 1981;126(5):591–3.
Roth B, Wissmeyer MP, Zehnder P, Birkhäuser FD, Thalmann GN, Krause TM, et al. A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder. Eur Urol. 2010;57(2):205–11.
Wright JL, Lin DW, Porter MP. The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer. 2008;112(11):2401–8.
Colombo R, Naspro R. Ileal conduit as the standard for urinary diversion after radical cystectomy for bladder cancer. Eur Urol Suppl. 2010;9(10):736–44.
Mischinger J, Abdelhafez MF, Rausch S, Todenhöfer T, Neumann E, Aufderklamm S, et al. Perioperative morbidity, bowel function and oncologic outcome after radical cystectomy and ileal orthotopic neobladder reconstruction: Studer-pouch versus I-pouch. Eur J Surg Oncol. 2018;44(1):178–84.
Almassi N, Zargar H, Ganesan V, Fergany A, Haber G-P. Management of challenging urethro-ileal anastomosis during robotic assisted radical cystectomy with intracorporeal neobladder formation. Eur Urol. 2016;69(4):704–9.
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Amend, B., Mourmouris, P., Wiklund, P., Stenzl, A., Tyritzis, S.I. (2022). Surgical Anatomy and Clinical Relevance to Robot-Assisted Cystectomy and Urinary Diversion. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_54
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