Are Early Continence Recovery and Oncologic Outcomes Influenced by Use of Different Devices in Prostatic Apex Dissection During Laparoscopic Radical Prostatectomy?

Is it the End for Urologic Pelvic Laparoscopic Surgery?

AIM

To scrutinize the rapid development of robotic versus traditional laparoscopic technique in pelvic urologic surgery.

INTRODUCTION

In the last few decades, advances in research and development have led to tremendous progress in medical diagnostics and treatment of disease. Minimally invasive surgery has moved from experimental to becoming the dominant form of surgical management across the surgical specialties. Laparoscopy is nowadays used widely in abdominal surgery, from simple diagnostic laparoscopy to complex colorectal and gynecologic cancer procedures.

METHODS

A literature search of electronic databases (PubMed, Medscape, Embase) using the key words: "pelvic laparoscopy, urologic oncology, robotic surgery, minimally invasive access" was performed for all relevant articles in the English language. Data were extrapolated from the abstracts alone to avoid subjective bias in drawing conclusions.

RESULTS

Telemedicine and telesurgery, the diagnostic and operative process is conducted from a distance. The surgeon uses computer-assisted surgery away from the bedside via a robotic system and performs the surgical task at hand. In pelvic urological cancer surgery the use of robotic technique expands to female and reconstructive procedures as well. The leap forward is so massive, that traditional laparoscopic surgery is starting to be considered less, with a growing number of organizations being now more interested in developing a robotic service. Minimally invasive surgical techniques aim to improve surgical outcome in conjunction with delivery of high-quality patient care. Quality studies demonstrating superiority and cost effectiveness are lacking, however.

CONCLUSIONS

Although tremendous accomplishments took place over a few years, there is still a lot of ground to be covered in standardizing the learning process and evaluating the outcome from the application of new technologies in the field of robotic pelvic surgery.

[Update on laparoscopic electrosurgical devices and their use in complex urologic procedures]

INTRODUCTION

Laparoscopy is the standard of care for many urologic procedures and witnesses nowadays technological advancements. Hemostasis is highly important in laparoscopy since bleeding could rapidly alter the operative conditions. The objective of this review is to expose the different electrosurgical techniques, their history and their applications in urology.

MATERIAL AND METHODS

A literature review was overdone using the following terms "laparoscopic electrosurgery" and/or "nephrectomy" and/or "prostatectomy". Two hundred and forty articles were found through Pubmed. After reviewing the title and the content of these articles, 18 were eligible for the following review.

RESULTS

The different electrosurgical techniques and their technological evolution are exposed. Physical properties of each system are exposed as well. Advantages and limitations of each system are also reviewed and analyzed.

CONCLUSION

Bipolar electrosurgery with thermofusion and ultrasound technology can achieve good results in terms of nerve sparing for radical laparoscopic prostatectomies. They can both be used in partial nephrectomies. However, they can compromise the surgical resection margins. Hybrid systems seem to have an important role in urological laparoscopic procedures despite the scarce number of available studies.

LEVEL OF EVIDENCE

3.

The fascial suspension of the prostate: A cadaveric study

AIMS

Analysis and description of the supporting fascial structure around the prostate and urethra, which needs to be preserved or restored during radical prostatectomy (RP).

METHODS

Anatomical dissection of 10 male cadavers was performed and the supporting fascial structures of bladder neck, prostate, and proximal urethra were investigated. The cadavers were embalmed according to Thiel's method, which preserves a natural texture and color of tissues.

RESULTS

Anteriorly, the puboprostatic ligament (PL), the dorsal vein complex, and the urethropelvic ligament form an integral structure that suspends and stabilizes the prostatic apex. Laterally, the fascia originates from the fascial tendinous arch of the pelvis and stabilizes the prostate in the central position. In the posterolateral aspect, we could demonstrate a tendineous dorsal raphe, which represents an important stabilization structure of the urethra.

CONCLUSIONS

The anterior and posterior pelvic fascial structure seems to be important stabilizer for the prostate and proximal urethra. Their preservation or reconstruction during RP is mandatory to restore the anatomic and functional continuity of the bladder neck and urethra. Neurourol. Urodynam. 36:1131-1135, 2017. © 2016 Wiley Periodicals, Inc.