Takenaka Atsushi, Leung Robert A, Fujisawa Masato, Tewari Ashutosh K
Department of Organs Therapeutics, Division of Urology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
World J Urol. 2006 Jun;24(2):136-43. doi: 10.1007/s00345-006-0102-2. Epub 2006 May 24.
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.
达芬奇机器人（直观外科公司，加利福尼亚州森尼韦尔市）凭借其放大的三维视觉和多关节腕部器械，使我们能够在考虑盆腔解剖结构的情况下进行根治性前列腺切除术。在本文中，我们回顾了与机器人前列腺切除术相关的盆腔自主神经解剖结构，并基于新的解剖学概念展示了保留神经的机器人根治性前列腺切除术的操作步骤和关键点。从30具新鲜男性尸体和25具固定男性尸体上获取了微观和宏观数据。对205例手术进行了视频研究，以确定与机器人前列腺切除术相关的解剖结构。从实际角度来看，我们可以将相关神经组织分为三个大致区域：（1）近端神经血管板（PNP），（2）主要神经血管束（PNB），（3）附属远端神经通路（ANP）。自主神经节细胞不仅广泛存在于神经成分中，也沿着内脏分布。保留神经手术的关键区域是PNP的远端、整个PNB以及尖部的周边。所有部位的细胞计数个体差异明显。基于这些概念，我们建立了用于保留神经前列腺切除术的无热机器人技术（ART）。手术和肿瘤学结果虽不成熟但可行。这些三区和神经节细胞概念可能对进行保留神经的机器人根治性前列腺切除术的新手外科医生有益。
