Dorsal Vein Complex Preserving Technique During Robot-Assisted Radical Prostatectomy

Kent Kanao; Hiroyuki Muramatsu; Shingo Morinaga; Ikuo Kobayashi; Keishi Kajikawa; Genya Nishikawa; Masahito Watanabe; Kogenta Nakamura

doi:10.1089/cren.2020.0021

Dorsal Vein Complex Preserving Technique During Robot-Assisted Radical Prostatectomy

J Endourol Case Rep. 2020 Sep 17;6(3):220-223. doi: 10.1089/cren.2020.0021. eCollection 2020.

Authors

Kent Kanao¹, Hiroyuki Muramatsu², Shingo Morinaga², Ikuo Kobayashi², Keishi Kajikawa², Genya Nishikawa², Masahito Watanabe², Kogenta Nakamura²

Affiliations

¹ Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
² Department of Urology, Aichi Medical University, Nagakute, Japan.

Abstract

Background: Recently, two techniques of robot-assisted radical prostatectomy (RARP), which preserve dorsal vein complex (DVC), endopelvic fascia, and full neurovascular bundle (NVB), through anterior approach were reported. The techniques in a relatively large workspace seem less technically demanding than Retzius-sparing RARP. In this case report, we present a further modified technique of transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia to reduce the technical demands. Case Presentation: In a routine evaluation, a 65-year-old man was shown to have a prostate-specific antigen level of 5.07 ng/mL. Prostatic biopsy revealed a Gleason score of 6 (3 + 3) adenocarcinoma in 2 of the 12 specimens, and the clinical stage was diagnosed as cT2aN0M0. RARP was performed including transperitoneal full NVB sparing, antegrade preservation of DVC, and division of endopelvic fascia to increase the prostate mobility and reduce technical demands. The patient completely gained continence on the day after removal of the catheter, and potency was recovered 30 days after surgery. Conclusion: Our DVC preservation technique in the transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia during RARP may be safe, reduce technical demands, and facilitate early recovery of continence and sexual function after surgery.

Keywords: dorsal vein complex preservation; robot; robot-assisted radical prostatectomy.