Table Of ContentJ.-U. Stolzenburg • Matthew T. Gettman • Evangelos N. Liatsikos (Eds.)
Endoscopic Extraperitoneal Radical Prostatectomy
Laparoscopic and Robot-Assisted Surgery
J.-U. Stolzenburg • M. T. Gettman • E. N. Liatsikos (Eds.)
Endoscopic
Extraperitoneal
Radical Prostatectomy
Laparoscopic and Robot-Assisted Surgery
With 197 Figures and 10 Tables
123
Stolzenburg, Jens-Uwe, MD, FRCS (Ed) Liatsikos, Evangelos N., MD, PhD
Professor and Chairman Assistant Professor of Urology
Department of Urology Department of Urology
Head of International Training University of Patras, School of Medicine
Centre of Urologic Laparoscopy 26500 Rio, Patras, Greece
University of Leipzig e-mail: [email protected]
Liebigstraße 20
04103 Leipzig, Germany
e-mail: [email protected]
Gettman, Matthew T., MD
Associate Professor
Department of Urology
Mayo Clinic
Gonda 7S, 200 1st Street SW
Rochester, MN 55905, USA
e-mail: [email protected]
Library of Congress Control Number: 22007934520
ISBN-978-3-540-45533-2 Springer Berlin Heidelberg New York
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Foreword
Minimally invasive interventions were a source of Word of mouth, however, remains the strongest in-
controversy as early as the beginning of the 1960s in fluence on individual patients, who gravitate to the
stone removal. A group of young, aggressive urolo- centres where satisfaction is highest. Distance and
gists gradually shortened the standard approach to time play an ever-decreasing role in their decisions.
the kidney to a few centimetres, developed special in- The Centre of Urologic Laparoscopy at the Univer-
struments for this purpose, and entered into competi- sity of Leipzig is among the leading institutions
tion with the general surgeons who were carrying out in terms of numbers of patients treated, and is peer-
cholecystectomies via mini-incisions. The arguments less in the number of courses offered each year
– shortening hospital stay, decreasing the need for and the number of participants. This book is thus a
postoperative pain therapy – were the same, until product of 10 years’ experience of performing and
PNL and ESWL achieved better results. teaching EERPE. All that has been learned is con-
Age and experience have always been the enemies tained between its covers.
of progress, but this did not prevent the development The reader just needs to glance at the chapter on
of laparoscopic techniques in urology, beginning with topographical anatomy to become enthralled by the
the detection of cryptorchid testes and retroperito- innovative three-dimensional functional depiction of
neal lymphadenectomy. Ten years ago I counselled the pelvic organs and their internal innervation. The
one of my most dextrous pupils to avoid laparoscopy. computer-aided portrayal sets new standards for the
He ignored my advice and is now one of the most future. The succinct text clearly outlines what we al-
sought-after urologists in Belgium. ready know and what remains to be discovered.
In the evolution of surgical techniques the wheel of The same is true for all the other chapters. Particu-
history has often rolled backwards. The widespread lar mention should be made of the unrivalled depth of
use of clamps in intestinal surgery is perhaps one of focus of the photographs and Gottfried Müller’s ex-
the most instructive examples of a broad return to cellent illustrations.
conventional techniques, with the newer methods be- In contrast to other books on this topic, a chapter
coming restricted to particular indications. is dedicated to the prevention and management of
It is only natural to mistrust a new technique – in complications.
this case EERPE – that one cannot perform oneself. The editors and authors are to be congratulated on
In the field of laparoscopy the investment in robots a splendid volume. The effort invested in anatomical
is so immense that a retreat in the foreseeable future studies, illustrations and animal experiments exceeds
seems unlikely. In the USA – the land of unlimited by far that in other comparable titles.
opportunities – robot-assisted radical prostate sur-
gery has become one of the financial pillars of 500
urological clinics, with up to three operations per day.
It thus seems likely that industry will exert more in- Mainz, March 2007
fluence than ever on the diffusion of laparoscopic
techniques. R. Hohenfellner
Preface
Endoscopic/laparoscopic extraperitoneal radical prost- book. Our main goal is to guide the urologist step by
atectomy has been established in the literature as an step through the procedure, aiming to make this
intriguing therapeutic option for the management of highly standardized technique reproducible. Every
carcinoma of the prostate. Endoscopic and robotic procedure is presented with numerous endoscopic
approaches have proved to be equally effective for the images and diagrams so that the reader can fully
management of localized prostate cancer. Nerve- comprehend the different surgical steps. Complica-
sparing endoscopic/laparoscopic and robotic radical tions and useful tips and tricks for their management
prostatectomy should aim to maintain sexual func- are described in detail.
tion and restore continence early after surgery with- We would like to thank Jens Mondry and Gottfried
out impairing the final oncological outcome. Müller for their significant contributions with regard
The advent of laparoscopy and robotics has revital- to computer imaging and design creation, respective-
ized the discussion pertaining to the anatomy of the ly. Furthermore, we would like to express our grati-
structures surrounding the prostate gland. Despite tude to all contributing authors for their significant
the different approaches for radical prostatectomy the scientific input.
key to better results is full understanding of the anat-
omy of the prostate, the bladder neck and the urethra.
A special chapter has thus been devoted to the anato-
my of the prostate and its surrounding structures.
There is a plethora of urology textbooks describing Jens-Uwe Stolzenburg
laparoscopic procedures in different ways. The pres- Matthew T. Gettman
ent book is more an atlas than a conventional text- Evangelos N. Liatsikos
Contents
1 History of Laparoscopy, Endoscopic 3 Equipment for Endoscopic
Extraperitoneal Radical Prostatectomy Extraperitoneal Radical Prostatectomy . 31
and Robotic Surgery . . . . . . . . . . . . . . 1
3.1 Recommended Set of Instruments
1.1 Historical Aspects of Laparoscopy and for Endoscopic Extraperitoneal
Endoscopic Extraperitoneal Radical Radical Prostatectomy . . . . . . . . . . . 33
Prostatectomy . . . . . . . . . . . . . . . . . 3 Jens-Uwe Stolzenburg
Stefanos Papadoukakis, Dirk Kusche,
Michael C. Truss 3.2 Advances in Image Processing . . . . . . . 37
Torsten Lüdtke, Christine Senet
1.2 Historical Overview of Robotic Radical
Prostatectomy . . . . . . . . . . . . . . . . . 7 4 Indications for Endoscopic
Matthew T. Gettman, Hubert John Extraperitoneal Radical Prostatectomy . 39
Jens-Uwe Stolzenburg, Evangelos Liatsikos,
2 Surgical Anatomy Lars-Christian Horn, Michael C. Truss
for Radical Prostatectomy . . . . . . . . . 11
5 Anaesthesia Considerations
2.1 Surgical Neuroanatomy in Radical Prostatectomy . . . . . . . . . . 49
of the Male Pelvis . . . . . . . . . . . . . . 13 Fritjoff Koenig, Bernd Aedtner,
Thilo Schwalenberg, Rudolph Hohenfellner, Markus Wehner, Robert Rabenalt,
Jochen Neuhaus, Matthias Winkler, Paraskevi Katsakiori, Kriton Filos,
Evangelos N. Liatsikos, Evangelos N. Liatsikos,
Jens-Uwe Stolzenburg Jens-Uwe Stolzenburg
2.2 Inter- and Intrafascial Dissection 6 Pelvic Lymphadenectomy in the
Technique of Nerve-sparing Radical Management of Prostate Cancer . . . . . 55
Prostatectomy . . . . . . . . . . . . . . . . 20 Sivaprakasam Sivalingam, H. Schwaibold
Jens-Uwe Stolzenburg, Jochen Neuhaus,
Thilo Schwalenberg, 7 Technique of Endoscopic Extraperitoneal
Katharina Spanel-Borowski, Sabine Löffler, Radical Prostatectomy – Step by Step . . 65
Rudolph Hohenfellner, Jens-Uwe Stolzenburg, Robert Rabenalt,
Evangelos N. Liatsikos Minh Do, Evangelos Liatsikos
2.3 The Muscular Systems 8 Troubelshooting . . . . . . . . . . . . . . 121
of the Bladder Neck and Urethra . . . . . 24 Jens-Uwe Stolzenburg, Minh Do,
Jens-Uwe Stolzenburg, Jochen Neuhaus, Robert Rabenalt, Anja Dietel,
Lars-Christian Horn, Evangelos N. Liatsikos, Heidemarie Pfeiffer, Frank Reinhardt,
Thilo Schwalenberg Michael C. Truss, Evangelos Liatsikos
Contents
9 Haemostasis in Radical 12 Modular Training in Endoscopic
Prostatectomy . . . . . . . . . . . . . . . 135 Extraperitoneal Radical Prostatectomy 169
Evangelos N. Liatsikos, Paraskevi Katsakiori, Jens-Uwe Stolzenburg, Robert Rabenalt,
Jens-Uwe Stolzenburg Minh Do, Michael Truss,
Shiv Mohan Bhanot, Hartwig Schwaibold,
10 Extraperitoneal Robotic Radical Kossen Ho, Chris Anderson, Alan McNeill,
Prostatectomy: Operative Technique – Paraskevi Katsakiori, Evangelos N. Liatsikos
Step by Step . . . . . . . . . . . . . . . . . 143
Hubert John, Matthew T. Gettman 13 Postoperative Management . . . . . . . 179
11 The Need for Classification 13.1 Inpatient Rehabilitation
of Complications of Radical of Post-Prostatectomy Incontinence . . 181
Prostatectomy . . . . . . . . . . . . . . . 161 S. Hoffmann, W. Hoffmann, U. Otto
Jens-Uwe Stolzenburg, Paraskevi Katsakiori,
Minh Do, Robert Rabenalt, 13.2 Rehabilitation of Erectile Function
Panagiotis Kalidonis, Thilo Schwalenberg, After Radical Prostatectomy . . . . . . . 187
Alan McNeil, Evangelos N. Liatsikos Klaus-Peter Jünemann
List of Contributors
Aedtner, Bernd, Dr. med. Gettman, Matthew T., MD
Department of Anaesthesiology Associate Professor
and Intensive Care Medicine Department of Urology
University of Leipzig Mayo Clinic
Liebigstraße 20 Gonda 7S, 200 1st Street SW
04103 Leipzig, Germany Rochester, MN 55905, USA
Anderson, Chris, MD Ho, Kossen, MD
Consultant , Department of Urology Hong Kong Urology Clinic
St Georges Hospital 510 Central Building, Pedder Street
London, UK Hong Kong, China
Bhanot, Shiv Mohan, MD Hoffmann, Susanne, Dr. med.
Consultant , Department of Urology Clinic Quellental
King George Hospital Wiesenweg 6
London, UK 34537 Bad Wildungen, Germany
Dietel, Anja, Dr. med. Hoffmann, W., Dr. med.
Department of Urology Clinic Quellental
University of Leipzig Wiesenweg 6
Liebigstraße 20 34537 Bad Wildungen, Germany
04103 Leipzig, Germany
Hohenfellner, Rudolf, Prof. Dr. med. em.
Do, Hoang Minh, Dr. med. Department of Urology
Department of Urology University of Mainz
University of Leipzig Saarstraße 21
Liebigstraße 20 55122 Mainz, Germany
04103 Leipzig, Germany
Horn, Lars-Christian, Prof. Dr. med.
Filos, Kritos, MD Institute of Pathology
Associate Professor, Department of Anaesthesiology University of Leipzig
and Intensive Care Medicine Liebigstraße 13
University of Patras 04103 Leipzig, Germany
26500 Rio, Patras, Greece
II List of Contributors
John, Hubert Andreas, PD Dr. med. McNeil, Alan, BmedSci, FRCS (Ed & Eng),
Department of Urology FRCS (Urol)
Clinic Hirslanden Consultant, Department of Urology
Witellikerstraße 40 Western General Hospital
8008 Zürich, Switzerland Crewe Road
Edinburgh, EH4 2XU, UK
Jünemann, Klaus-Peter, Prof. Dr. med.
Chairman, Department of Urology Neuhaus, Jochen, Dr. rer. nat.
University of Kiel Department of Urology
Olshausenstraße 40 University of Leipzig
24118 Kiel, Germany Liebigstraße 20
04103 Leipzig, Germany
Kallidonis, Panagiotis, MD
Department of Urology Otto, U., Prof. Dr. med.
University of Patras Clinic Quellental
26500 Rio, Patras, Greece Wiesenweg 6
34537 Bad Wildungen, Germany
Katsakiori, Paraskevi, MD
Department of Urology Papadoukakis, Stefanos, MD
University of Patras Department of Urology
26500 Rio, Patras, Greece Klinikum Dortmund gGmbH
Beurhausstraße 40
König, Fritjoff, Prof. Dr. med. 44137 Dortmund, Germany
Department of Anaesthesiology
and Intensive Care Medicine Pfeiffer, Heidemarie, Dr. med.
University of Leipzig Department of Urology
Liebigstraße 20 University of Leipzig
04103 Leipzig, Germany Liebigstraße 20
04103 Leipzig, Germany
Kusche, Dirk, Dr. med.
Department of Urology Rabenalt, Robert, Dr. med.
Klinikum Dortmund gGmbH Department of Urology
Beurhausstraße 40 University of Leipzig
44137 Dortmund, Germany Liebigstraße 20
04103 Leipzig, Germany
Liatsikos, Evangelos N., MD, PhD
Assistant Professor Schwaibold, Hartwig, Dr. med.
Department of Urology Chairman, Department of Urology
University of Patras Kliniken am Steinenberg
26500 Rio, Patras, Greece Steinenbergstraße 25
72764 Reutlingen, Germany
Loeffler, Sabine, Dr. rer. nat.
Institute of Anatomy Schwalenberg, Thilo, Dr. med.
University of Leipzig Department of Urology
Liebigstraße 13 University of Leipzig
04103 Leipzig, Germany Liebigstraße 20
04103 Leipzig, Germany
Luedtke, Torsten
Olympus Optical Co. (Europa) GmbH
Wendenstraße 14–18
20097 Hamburg, Germany
