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Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy

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Abstract

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers. A video study of 205 surgeries was performed for establishing the anatomy relevant to robotic prostatectomy. From a practical standpoint, we could group the relevant neural tissue into three broad zones: (1) proximal neurovascular plate (PNP), (2) predominant neurovascular bundles (PNB), (3) accessory distal neural pathways (ANP). Autonomic ganglion cells existed widely not only in nerve components but also along the viscera. The critical areas of nerve sparing surgery were the distal end of PNP, the entire PNB, and the circumference of the apex. Interindividual differences of cell counts were evident in all sites. Based on these concepts, we established the Athermal Robotic Technique (ART) for nerve sparing prostatectomy. Surgical and oncological outcomes were not mature but feasible. These tri-zonal and ganglion cell concepts may be of benefit to new surgeons undertaking nerve-sparing robotic radical prostatectomy.

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Acknowledgments

The authors thank Professor Mani Menon for the intellectual interaction about the nerve preservation and for establishing the foundations for robotic prostatectomy by popularizing the VIP technique of prostatectomy. We are also grateful to Professor Gen Murakami in Department of Anatomy, Sapporo Medical University, Japan, for supplying the fresh and fixed cadavers and helpful technical comment in the anatomic study. Many thanks to Professor Georg Bartsch in Department of Urology, Medical University of Innsbruck, Austria, for his comments on clinical anatomy.

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Authors and Affiliations

  1. Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Starr 900, New York, NY, 10021, USA

    Robert A. Leung & Ashutosh K. Tewari

  2. Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Atsushi Takenaka & Masato Fujisawa

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  1. Atsushi Takenaka
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  2. Robert A. Leung
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  3. Masato Fujisawa
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  4. Ashutosh K. Tewari
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Correspondence to Atsushi Takenaka.

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Takenaka, A., Leung, R.A., Fujisawa, M. et al. Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy. World J Urol 24, 136–143 (2006). https://doi.org/10.1007/s00345-006-0102-2

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  • DOI: https://doi.org/10.1007/s00345-006-0102-2

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