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Radical Prostatectomy: Anterior Approach

  • Charles-Henry Rochat
Chapter

Abstract

The anterior approach both for open and laparoscopic surgery is the one best known among urologists. The prostate is approached from above after lowering the bladder. The bladder neck is then sectioned to reach the ampulla and seminal glands.

These preparatory steps are well described in the curriculum prepared and presented by the EAU/ERUS to teach robotic prostatectomies. The anterior approach is accomplished by a single incision of the peritoneum which also allows for an extensive lymphadenectomy if indicated. With the required expertise this approach also allows for correction of inguinal hernias whether discovered intraoperatively or known beforehand.

The technique consisting of first approaching the bloc of ampulla and seminal glands (see chapter on the posterior approach) should also be known by urologist in specific situations, for example T3 tumours or after radiotherapy, in order to be sure of the feasibility of the prostate-rectal cleavage.

Keywords

Laparoscopic prostatectomy Robot-assisted prostatectomy Anterior approach 

Suggested Readings

  1. Akand M, et al. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: a prospective single surgeon randomized comparative study. Int J Urol. 2015;22(10):916–21.CrossRefPubMedGoogle Scholar
  2. Al-Shareef AH, et al. Effects of previous hernia repair on extraperitoneal robotic assisted radical prostatectomy; a matched-pair analysis study. J Endourol. 2015;29(10):1143–7.CrossRefPubMedGoogle Scholar
  3. Asimakopoulos AD, et al. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: critical appraisal of the anatomic landmarks for a complete intrafascial approach. Clin Anat. 2015;28(7):896–902.CrossRefPubMedGoogle Scholar
  4. Chang SL, et al. The impact of robotic surgery on the surgical management of prostate cancer in the USA. BJU Int. 2015;115(6):929–36.CrossRefPubMedGoogle Scholar
  5. De Carlo F, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int. 2014;93(4):373–83.CrossRefPubMedGoogle Scholar
  6. Galfano A, di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM. Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with 1 year follow-up. Eur Urol. 2013;64(6):974–80.CrossRefPubMedGoogle Scholar
  7. Graefen M, et al. Outcome of radical prostatectomy: Is it the approach or the surgical expertise? Eur Urol. 2014;66(3):557–8.CrossRefGoogle Scholar
  8. Hattori K. Robot-assisted radical prostatectomy: trans-peritoneal anterior approach. Jpn J Clin Urol. 2015;69(10):810–7.Google Scholar
  9. Horovitz D, et al. Extraperitoneal vs. transperitoneal robot-assisted radical prostatectomy. J Endourol. 2017a;31(4):366–73.CrossRefPubMedGoogle Scholar
  10. Horovitz D, et al. Extraperitoneal vs. transperitoneal robot-assisted radical prostatectomy in the setting of prior abdominal or pelvic surgery. J Endourol. 2017b;31(4):366–73.CrossRefPubMedGoogle Scholar
  11. Kaler K, et al. Minimally invasive hernia repair in robot-assisted radical prostatectomy. J Endourol. 2016;30(10):1036–40.CrossRefPubMedGoogle Scholar
  12. Laird A, et al. Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: a report of national outcomes. BJU Int. 2015;115(5):753–63.CrossRefPubMedGoogle Scholar
  13. Ludwig W, et al. Inguinal hernia repair during extraperitoneal robot-assisted laparoscopic radical prostatectomy. J Endourol. 2015;30(2):208–11.CrossRefPubMedGoogle Scholar
  14. Qazi HA, et al. Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience. Cent European J Urol. 2015;68(2):240–4.PubMedPubMedCentralGoogle Scholar
  15. Vricella GJ, et al. Retrograde robotic radical prostatectomy: description of a new technique and early perioperative outcomes. ISRN Urol. 2014;2014:945604.PubMedPubMedCentralGoogle Scholar
  16. Yasui T, et al. Outcomes of robot-assisted laparoscopic prostatectomy with a posterior approach to the seminal vesicle in 300 patients. ISRN Urol. 2014;2014:565737.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Swiss International Prostate Center Geneva, sipc-urology.chClinic General Beaulieu GenevaGenevaSwitzerland

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