AB10. Laparoscopic radical anatomy of prostatectomy

Abstract: In recent years, laparoscopic radical prostatectomy (LRP) has been established as a safe and effective treatment for localized prostate cancer. With better visualization of the anatomy, LRP has the potential to provide a gold standardization for prostate cancer. However, outcomes include urinary incontinence, bleeding and sexual dysfunction, which can have significant adverse effects on quality of life, remains a huge challenge. Here, we have performed laparoscopic radical anatomy of prostatectomy for localized prostate cancer, and obtained satisfactory effects. Experience including: We are familiar with the local anatomy of prostate in preoperative, and carefully identify important anatomic symbols, such as bilateral fascia reflexed, the junction of bladder and prostate in intraoperative; We identify correct anatomy of prostate to avoid blind clamp, burning, and properly handle the fascia reflexed, penile deep dorsal neurovascular complex and prostate lateral ligament to avoid blood loss; We are carefully isolate the junction of bladder neck and prostate, which is an important part of controlling urination; Fully open Dirichlet fascia when we isolate the dorsal prostate, and along the anterior rectum gap close to the prostate to separate the apex of prostate; It is as much as possible to retain the urethral length when the separation of the apex of the prostate, and cut off urethra close to the apex of the prostate with scissors; Then a careful dissection of the prostate laterally from its periprostatic fascia was performed with preservation of the nerves and vessels contained in the fascias, we open Dirichlet fascia along the seminal vesicle basal, close to the prostatic fascia isolate prostate dorsal until the apex of the prostate called as interfascial technique, and cut off the endopelvic fascia only ventrally and medially to the puboprostatic ligaments were spared called as intrafascial technique; Single needle suture plus V-Loc one-way barbs suture in the urethra 5, 7, 10, 12, 2 point continuous suture to relieve the tension, shorten the operation time, and reduce the occurrence of leakage of urine.

Keywords: Laparoscopic radical prostatectomy (LRP); prostate cancer; anatomy