Skip to main content

Surgical Anatomy and Clinical Relevance to Robot-Assisted Cystectomy and Urinary Diversion

  • Chapter
  • First Online:
Robotic Urologic Surgery

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Benninghoff D. Anatomy. 16th ed. München: Urban & Fischer Verlag; 2003.

    Google Scholar 

  2. Campbell MF, Wein AJ, Kavoussi LR. In: Wein AJ, Kavoussi LR, et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia: W.B. Saunders; 2007.

    Google Scholar 

  3. Netter FH. Atlas of human anatomy. 1st ed. Stuttgart: Thieme; 1997.

    Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Stolzenburg JU, Schwalenberg T, Horn LC, Neuhaus J, Constantinides C, Liatsikos EN. Anatomical landmarks of radical prostatecomy. Eur Urol. 2007;51(3):629–39.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  10. Young HH. The radical cure of cancer of the prostate. Surg Gynecol Obstet. 1937;64:472–84.

    Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Richards KA, Steinberg GD. Perioperative outcomes in radical cystectomy: how to reduce morbidity? Curr Opin Urol. 2013;23(5):456–65.

    Article  PubMed  Google Scholar 

  14. Schilling D, Horstmann M, Nagele U, Sievert KD, Stenzl A. Cystectomy in women. BJU Int. 2008;102(9 Pt B):1289–95.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Baader B, Baader SL, Herrmann M, Stenzl A. Autonomic innervation of the female pelvis. Anatomic basis. Urologe A. 2004;43(2):133–40.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Hutch JA. Saccule formation at the ureterovesical junction in smooth walled bladders. J Urol. 1961;86:390–9.

    Article  CAS  PubMed  Google Scholar 

  21. 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.

    Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Oelrich TM. The urethral sphincter muscle in the male. Am J Anat. 1980;158(2):229–46.

    Article  CAS  PubMed  Google Scholar 

  24. Oelrich TM. The striated urogenital sphincter muscle in the female. Anat Rec. 1983;205(2):223–32.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Stein TA, DeLancey JO. Structure of the perineal membrane in females: gross and microscopic anatomy. Obstet Gynecol. 2008;111(3):686–93.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wallner C, Dabhoiwala NF, Deruiter MC, Lamers WH. The anatomical components of urinary continence. Eur Urol. 2008;

    Google Scholar 

  28. Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  CAS  PubMed  Google Scholar 

  30. Smith JA Jr, Whitmore WF Jr. Regional lymph node metastasis from bladder cancer. J Urol. 1981;126(5):591–3.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-00363-9_54

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-00362-2

  • Online ISBN: 978-3-031-00363-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics