Abstract
This chapter describes the novel “Hood technique” for robotic-assisted radical prostatectomy (RARP) that is a simple, reproducible, adaptable approach of Anatomic Robotic Technique of removing prostate cancer. This technique preserves contents of space of Retzius and permits visualization of ureteric orifices and median lobes. The Hood technique also allows various grades of nerve sparing to occur in athermal manner and surgeon could focus on time tested anatomic principles to achieve trifecta. We have previously described our nerve sparing technique thus in this chapter we will focus on hood techniques impact on continence. First, we detail the structures that constitute the “Hood”. Then we will tie this to the anatomical foundations of urinary continence, including innervation to the urethra sphincter, the support structures of the sphincteric complex, and the components of urethral sphincter complex, that contribute to the pathophysiology of post-RARP urinary incontinence (PPI). We then describe our novel “Hood” concept and technique, an anterior approach designed to better preserve the anatomical structures surrounding the urethra—the space of Retzius and pouch of Douglas, to facilitate early return of continence. A step-by-step outline of the technique, as it was performed in patients using a four-arm da Vinci Xi System, is presented. We compared the results of patients of 272 patients who underwent the “Hood technique” for RARP and those of 58 patients who underwent an existing non-Hood RARP strategy using the same da Vinci System. Continence rates with the “Hood technique” at 1, 2, 4, 6, 12, and 24 weeks after catheter removal were 21%, 36%, 83%, 93%, and 94%; continence rates with the non-Hood technique at the same time points were 12%, 22%, 76%, 85%, 86%, and 88%. The Hood technique has shown to achieve early return of continence, better functional outcomes, and improve quality of life and survival without a negative impact on complications and cancer outcomes.
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References
Sandoval Salinas C, González Rangel AL, Cataño Cataño JG, Fuentes Pachón JC, Castillo Londoño JS. Efficacy of robotic-assisted prostatectomy in localized prostate cancer: a systematic review of clinical trials. Adv Urol. 2013;2013:105651.
Wagaskar VG, Mittal A, Sobotka S, Ratnani P, Lantz A, Falagario UG, et al. Hood technique for robotic radical prostatectomy-preserving periurethral anatomical structures in the space of Retzius and sparing the pouch of Douglas, enabling early return of continence without compromising surgical margin rates. Eur Urol. 2021;80(2):213–21.
Hwang J, Kim B, Uchio E. Improving urinary continence after radical prostatectomy: review of surgical modifications. Korean J Urol. 2009;50:935–41.
Golomb J, Chertin B, Mor Y. Anatomy of urinary continence and neurogenic incontinence. Therapy. 2009;6(2):151–5.
Bessede T, Sooriakumaran P, Takenaka A, Tewari A. Neural supply of the male urethral sphincter: comprehensive anatomical review and implications for continence recovery after radical prostatectomy. World J Urol. 2017;35(4):549–6.
Ikeda Y. Neurophysiological control of urinary bladder storage and voiding—functional changes through development and pathology. Pediatr Nephrol. 2021;36(5):1041–52.
Groat W, Yoshimura N. Afferent nerve regulation of bladder function in health and disease. Handb Exp Pharmacol. 2009;194:91–138.
Groat W, Yoshimura N. Anatomy and physiology of the lower urinary tract. Handb Clin Neurol. 2015;130:61–108.
Srivastava A, Grover S, Sooriakumaran P, Tan G, Takenaka A, Tewari AK. Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol. 2011;21(1):49–59.
Nyangoh Timoh K, Moszkowicz D, Creze M, Zaitouna M, Felber M, Lebacle C, et al. The male external urethral sphincter is autonomically innervated. Clin Anat. 2021;34(2):263–71.
Reeves F, Everaerts W, Murphy DG, Costello A. Chapter 29: The surgical anatomy of the prostate. In: Mydlo JH, Godec CJ, editors. Prostate cancer. 2nd ed. San Diego: Academic; 2016. p. 253–63.
Gandaglia G, Briganti A, Suardi N, Gallina A, Cucchiara V, Vizziello D, et al. Fascial layers in nerve sparing robot-assisted radical prostatectomy. Urol Pract. 2014;1(2):86–91.
Takenaka A, Tewari AK. Anatomical basis for carrying out a state-of-the-art radical prostatectomy. Int J Urol. 2012;19(1):7–19.
Myers RP. Detrusor apron, associated vascular plexus, and avascular plane: relevance to radical retropubic prostatectomy—anatomic and surgical commentary. Urology. 2002;59(4):472–9.
Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9.
Cho DS, Choo SH, Kim SJ, Shim KH, Park SG, Kim SI. Postoperative membranous urethral length is the single most important surgical factor predicting recovery of postoperative urinary continence. Urol Oncol. 2020;38(12):930.e7–930.e12.
Sugi M, Kinoshita H, Yoshida T, Taniguchi H, Mishima T, Yoshida K, et al. The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy. Scand J Urol. 2018;52(2):151–6.
Tewari A, Jhaveri J, Rao S, Yadav R, Bartsch G, Te A, et al. Total reconstruction of the vesico-urethral junction. BJU Int. 2008;101(7):871–7.
Haga N, Ogawa S, Yabe M, Akaihata H, Hata J, Sato Y, et al. Association between postoperative pelvic anatomic features on magnetic resonance imaging and lower tract urinary symptoms after radical prostatectomy. Urology. 2014;84(3):642–9.
Kretschmer A, Nitti V. Surgical treatment of male postprostatectomy incontinence: current concepts. Eur Urol Focus. 2017;3(4–5):364–76.
Shin TY, Lee YS. Detrusorrhaphy during robot-assisted radical prostatectomy: early recovery of urinary continence and surgical technique. Biomed Res Int. 2019;2019:1528142.
Chung M, Lee SH, Jung H, Park W, Chung B. Impact of a retrotrigonal layer backup stitch on post-prostatectomy incontinence. Korean J Urol. 2011;52:709–14.
Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol. 2010;58(3):457–61.
Tewari A, El-Hakim A, Rao S, Raman JD. Identification of the retrotrigonal layer as a key anatomical landmark during robotically assisted radical prostatectomy. BJU Int. 2006;98(4):829–32.
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We thank Ms. Sima Rabinowitz for editorial assistance.
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Tewari, A., Wagaskar, V., Ratnani, P., Parekh, S., Pedraza, A., Shukla, B. (2022). The Hood Technique for Robotic-Assisted Radical Prostatectomy: Preserving Vital Structures in the Space of Retzius and the Pouch of Douglas. In: Ren, S., Nathan, S., Pavan, N., Gu, D., Sridhar, A., Autorino, R. (eds) Robot-Assisted Radical Prostatectomy. Springer, Cham. https://doi.org/10.1007/978-3-031-05855-4_11
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DOI: https://doi.org/10.1007/978-3-031-05855-4_11
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