AB083. Anatomical landmarks for minimally invasive radical prostatectomy

Since the initial study of nerve sparing radical prostatectomy by Walsh, the surgical treatment of prostate cancer has evolved substantially and is still evolving. Laparoscopic radical prostatectomy firstly described in 1992 by Schuessler et al. is established as a safe and effective therapeutic approach for prostate cancer in specialized urologic centers. Although laparoscopic radical prostatectomy had a steep learning curve, the enhanced visibility provided to the surgeon by magnification allows for a better definition of anatomical landmarks, which were not apparent with open, non-magnified surgery. The da Vinci surgical system was developed in 1999. Afterward, robot-assisted laparoscopic prostatectomy was initially reported in 2001. Since the operative procedure was established by Menon et al. the next year, robot-assisted laparoscopic prostatectomy has been widely expanded. The advent of the robot to assist laparoscopic surgery served as a platform to enhance the surgeon’ laparoscopic skills and to define further technological needs, such as better 3D vision systems and the development of hand-held articulating instruments. Oncologic results (surgical margin status) and quality of life aspects (continence preservation and postoperative urinary continence) are issues that provoke further technical modifications, aiming to achieve the ideal outcome. Advances in the understanding of prostate and pelvic anatomy in recent years made a substantial contribution to improve the surgical technique for the treatment of prostate cancer with the potential preservation of anatomic structures responsible for erectile and urinary function postoperatively. Exact knowledge of these anatomic structures is the key to achieve a complete removal of the prostate and seminal vesicles while preserving the best possible quality of life.