Robotic Radical Prostatectomy: A decade of Evolution A . Mottrie G. Denaeyer, P. Schatteman, P. Carpentier, E. Fonteyne O....
Robot-assisted surgery indications <ul><li>Major indication : </li></ul><ul><li>radical prostatectomy </li></ul><ul><li>Su...
<ul><li>20% </li></ul><ul><li>0.7% </li></ul><ul><li>79.3% </li></ul><ul><li>Urology Marketing </li></ul>Robot-assisted Pr...
Surgical Anatomy of the Prostate <ul><li>Dr Pat Walsh </li></ul><ul><li>“ it is humbling to realize that even today basic ...
Surgical Anatomy of the Prostate The Challenge <ul><li>The challenge: </li></ul><ul><li>How much periprostatic tissue must...
Robot-assisted prostatectomy Sparing neurovascular bundles <ul><li>M. Menon, P. Walsh </li></ul>
Robot-assisted prostatectomy Sparing neurovascular bundles <ul><li>M. Menon, P. Walsh </li></ul>
Robot-assisted prostatectomy Sparing neurovascular bundles Veil of Aphrodite <ul><li>M. Menon, P. Walsh </li></ul>
Surgical Anatomy of the Prostate Proximal neurovascular plate Accessory neural pathways Predominant neurovascular bundle <...
Surgical Anatomy of the Prostate Pelvic plexus HGN (sympathetic: hypogastric)) <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
R-A rad. prostatectomy    technique : nerve-sparing LEVATOR ANI FASCIA LEVATOR ANI FASCIA LAT PROST FASCIA <ul><li>A. Vill...
Fascial planes of dissection are  numerous. What are the options ? Intra fascial  (endo fascial) plane: fascia  absent  on...
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate I. Prostatic capsula <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate II. Inconsistent fascia on arteries & veins <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate III. Multilayer lateral prostatic fascia <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate IV. Levator fascia <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
Surgical Anatomy of the Prostate Interfascial dissection
R-A rad. prostatectomy    technique : nerve-sparing RP specimen Thin layer of visceral Fascia left on the  prostatic  Pseu...
Surgical Anatomy of the Prostate <ul><li>To preserve  erectile function : </li></ul><ul><li>nerve sparing </li></ul><ul><l...
Surgical Anatomy of the Prostate
Surgical Anatomy of the Prostate
Surgical Anatomy of the Prostate
Surgical Anatomy of the Prostate
Robotics in urology Conclusion “ It’s like driving a limousine instead of a compact car.  With both, you can do the same d...
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Rrp a decade of evolution

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  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The following slide reviews the surgical market share for dVP in the U.S. We clearly end this past year at over 20%. Please note that LRP (Laparoscopic Radical Prostatectomy) now makes up less than 1% of all radical prostatectomy procedures performed in the U.S.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • The origin of this ureteral stenosis was peroperatively found to be endometriosis.
  • Rrp a decade of evolution

    1. 1. Robotic Radical Prostatectomy: A decade of Evolution A . Mottrie G. Denaeyer, P. Schatteman, P. Carpentier, E. Fonteyne O.L.V. Clinic Aalst Belgium
    2. 2. Robot-assisted surgery indications <ul><li>Major indication : </li></ul><ul><li>radical prostatectomy </li></ul><ul><li>Surgery is in constant motion </li></ul><ul><li>Looking for perfection to reach the “TRIFECTA” </li></ul><ul><li>Cure the patient from his cancer </li></ul><ul><li>Obtaining early continence </li></ul><ul><li>Preserving erectile function </li></ul>
    3. 3. <ul><li>20% </li></ul><ul><li>0.7% </li></ul><ul><li>79.3% </li></ul><ul><li>Urology Marketing </li></ul>Robot-assisted Prostatectomy Thanks to robotic surgery, more insights in microanatomy
    4. 4. Surgical Anatomy of the Prostate <ul><li>Dr Pat Walsh </li></ul><ul><li>“ it is humbling to realize that even today basic </li></ul><ul><ul><ul><ul><li>anatomy may not be known or understood” </li></ul></ul></ul></ul><ul><li>J Urol 1998; 160:2418 </li></ul><ul><li>“ you only see what you are looking for and you </li></ul><ul><li>only look for what you know” </li></ul><ul><li>AUA Course, 2006, Atlanta </li></ul>
    5. 5. Surgical Anatomy of the Prostate The Challenge <ul><li>The challenge: </li></ul><ul><li>How much periprostatic tissue must we spare to preserve erectile function? </li></ul><ul><li>How close may we dissect on the prostate without jeopardising oncological outcome? </li></ul>
    6. 6. Robot-assisted prostatectomy Sparing neurovascular bundles <ul><li>M. Menon, P. Walsh </li></ul>
    7. 7. Robot-assisted prostatectomy Sparing neurovascular bundles <ul><li>M. Menon, P. Walsh </li></ul>
    8. 8. Robot-assisted prostatectomy Sparing neurovascular bundles Veil of Aphrodite <ul><li>M. Menon, P. Walsh </li></ul>
    9. 9. Surgical Anatomy of the Prostate Proximal neurovascular plate Accessory neural pathways Predominant neurovascular bundle <ul><li>A. Tewari </li></ul>
    10. 10. Surgical Anatomy of the Prostate Pelvic plexus HGN (sympathetic: hypogastric)) <ul><li>A. Tewari </li></ul>
    11. 11. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    12. 12. Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
    13. 13. Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
    14. 14. Surgical Anatomy of the Prostate Posterior neurovascular plate <ul><li>A. Tewari </li></ul>
    15. 15. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    16. 16. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    17. 17. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    18. 18. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    19. 19. R-A rad. prostatectomy technique : nerve-sparing LEVATOR ANI FASCIA LEVATOR ANI FASCIA LAT PROST FASCIA <ul><li>A. Villers et al. </li></ul>
    20. 20. Fascial planes of dissection are numerous. What are the options ? Intra fascial (endo fascial) plane: fascia absent on the specimen (glandular tissue at margin !) Inter fascial (inter visceral fascial layers) plane: fascia partly present on the specimen (NVB sparing) Extra fascial plane: fascia entirely present on the specimen <ul><li>A. Villers et al. </li></ul>
    21. 21. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    22. 22. Surgical Anatomy of the Prostate I. Prostatic capsula <ul><li>A. Tewari </li></ul>
    23. 23. Surgical Anatomy of the Prostate II. Inconsistent fascia on arteries & veins <ul><li>A. Tewari </li></ul>
    24. 24. Surgical Anatomy of the Prostate III. Multilayer lateral prostatic fascia <ul><li>A. Tewari </li></ul>
    25. 25. Surgical Anatomy of the Prostate IV. Levator fascia <ul><li>A. Tewari </li></ul>
    26. 26. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    27. 27. Surgical Anatomy of the Prostate <ul><li>A. Tewari </li></ul>
    28. 28. Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
    29. 29. Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
    30. 30. Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
    31. 31. Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
    32. 32. Surgical Anatomy of the Prostate Planes of dissection <ul><li>A. Tewari </li></ul>
    33. 33. Surgical Anatomy of the Prostate Interfascial dissection
    34. 34. R-A rad. prostatectomy technique : nerve-sparing RP specimen Thin layer of visceral Fascia left on the prostatic Pseudo capsule <ul><li>A. Villers et al. </li></ul>
    35. 35. Surgical Anatomy of the Prostate <ul><li>To preserve erectile function : </li></ul><ul><li>nerve sparing </li></ul><ul><li>preservation of blood supply </li></ul>
    36. 36. Surgical Anatomy of the Prostate
    37. 37. Surgical Anatomy of the Prostate
    38. 38. Surgical Anatomy of the Prostate
    39. 39. Surgical Anatomy of the Prostate
    40. 40. Robotics in urology Conclusion “ It’s like driving a limousine instead of a compact car. With both, you can do the same distance, but with a limousine, it’s easier, safer & more comfortable”
    41. 41. Invitation

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