Gandaglia Giorgio, Briganti Alberto, Suardi Nazareno, Gallina Andrea, Cucchiara Vito, Vizziello Damiano, Zaffuto Emanuele, Moschini Marco, Montorsi Francesco
Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
Urol Pract. 2014 Jul;1(2):86-91. doi: 10.1016/j.urpr.2014.03.002. Epub 2014 Apr 17.
The identification of prostatic fascial layers is of paramount importance for oncologic and functional outcomes in patients with localized prostate cancer treated with robot-assisted radical prostatectomy. We evaluated the relationship between the prostatic fascial layers and the nerve structures responsible for urinary continence and erection. Additionally, we examined how dissection of these structures might influence the degree of nerve sparing in the robotic era.
We performed a systematic literature review of the MEDLINE®, Embase™ and Web of Science™ databases. The search strategy included the terms radical prostatectomy, neurovascular bundles, nerve sparing, anatomy, robot-assisted prostatectomy and fascial layers.
The prostatic fasciae represent an important dissection plane. These anatomical structures are in close relationship with the neurovascular bundles and periprostatic nerve fibers, which spread widely from the posterolateral surface of the prostate to the anterolateral portion. During robot-assisted radical prostatectomy 2 main fascial layers might be identified, including the endopelvic fascia and the prostatic fascia. Identification and preservation of these structures allows for maximizing the sparing of nerve fibers related to continence and erection. Robotic surgeons have proposed 3 dissection planes associated with a different degree of nerve sparing, including intrafascial, interfascial and extrafascial dissection.
The visual magnification typical of robot-assisted radical prostatectomy facilitates the identification of prostatic fasciae, allowing the surgeon to tailor the extent of dissection to patient clinical and disease characteristics.
对于接受机器人辅助根治性前列腺切除术治疗的局限性前列腺癌患者，识别前列腺筋膜层对于肿瘤学和功能结局至关重要。我们评估了前列腺筋膜层与负责尿失禁和勃起的神经结构之间的关系。此外，我们研究了在机器人时代对这些结构的解剖如何影响神经保留程度。
我们对MEDLINE®、Embase™和Web of Science™数据库进行了系统的文献综述。检索策略包括根治性前列腺切除术、神经血管束、神经保留、解剖学、机器人辅助前列腺切除术和筋膜层等术语。
前列腺筋膜代表一个重要的解剖平面。这些解剖结构与神经血管束和前列腺周围神经纤维密切相关，这些神经纤维从前列腺后外侧表面广泛分布至前外侧部分。在机器人辅助根治性前列腺切除术中，可能识别出2个主要筋膜层，包括盆内筋膜和前列腺筋膜。识别并保留这些结构可最大限度地保留与尿失禁和勃起相关的神经纤维。机器人手术医生提出了3个与不同程度神经保留相关的解剖平面，包括筋膜内、筋膜间和筋膜外解剖。
机器人辅助根治性前列腺切除术特有的视觉放大功能有助于识别前列腺筋膜，使外科医生能够根据患者的临床和疾病特征调整解剖范围。
