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Laparoscopic Radical Cystoprostatectomy
Published in Qais Hooti, Sung-Hoo Hong, Minimally Invasive Urologic Surgery, 2023
The Denonvilliers’ fascia is seen stretched posteriorly; its attachment to prostate is opened horizontally and an intra-fascial plane is created if nerve sparing approach is planned (Figure 9.13).
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
Clinically, it is important to note that, whilst histologically Denonvilliers’ fascia has two distinguishable layers that reflect its development, it is not possible to discern two separate layers during pelvic dissection and there is no ‘posterior layer’. The term ‘posterior layer’ persists in the literature causing misconceptions and it is, in fact, the fascia propria of the rectum.9 Any reports of dissection ‘between the two layers of Denonvilliers’ fascia’ are, in reality, a dissection between the fascia propria of the rectum and the true Denonvilliers’ fascia that lies over the prostate and seminal vesicles.
MRI Imaging of Seminal Vesicle Invasion (SVI) in Prostate Adenocarcinoma
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
Samuel A. Gold, Graham R. Hale, Kareem N. Rayn, Vladimir Valera, Jonathan B. Bloom, Peter A. Pinto
The prostate gland is surrounded by the prostatic capsule, which is not a true capsule, but instead a fibromuscular layer on the exterior of the prostate. It is made up of an outer collagen band with an inner smooth muscle component that together cannot be separated from the prostatic tissue. The prostatic capsule covers the entire prostate with the key exceptions of the prostatic apex and the points of insertion for the ejaculatory ducts near the seminal vesicles [8]. Surrounding the prostate and the prostatic capsule is periprostatic adipose tissue. Furthermore, posterior to the prostate is the rectoprosatic fascia, also named Denonvilliers’ fascia. It functions as a physical barrier between the prostate and the muscular rectum beneath.
Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon
Published in Arab Journal of Urology, 2021
Muhieddine Labban, Muhammad Bulbul, Wassim Wazzan, Raja Khauli, Albert El Hajj
The RARP is started by first reflecting the bladder off the anterior abdominal wall. After the dissection of the space of Retzius, the prostate is identified and cleaned off. Then, the endopelvic fascia is carefully dissected and opened in order to dissect the space between the prostate and the levator ani muscle. This step is performed bilaterally. After dividing the anterior bladder neck at the prostate-vesical junction, the Foley catheter is identified within the bladder and grabbed with the fourth robotic arm to lift the prostate. Consequently, the posterior bladder neck is divided carefully and the dissection is carried through the posterior layers of the bladder wall. The vas deferens and seminal vesicles are then identified on either side and carefully dissected free. Next, Denonvilliers’ fascia is divided at the plane between the posterior surface of the prostate and the rectum could be developed. The prostatic pedicles are then divided and sealed using Hem-o-lok clips. On a case-by-case basis, intrafascial or interfascial nerve sparing could be performed. At the apex of the prostate, the dorsal vein is identified and a V-Loc suture is applied to the dorsal vein in order to tie it off and suspended to the pubic bone. The dorsal vein complex and the apex of the prostate should be divided carefully and then the rectourethralis muscle is divided sharply. As such, the prostate specimen is completely freed and placed in an EndoCatch bag.
Robotic sacrocolpopexy for recurrent vaginal vault prolapse after sex reassignment surgery in a trans-woman
Published in Journal of Obstetrics and Gynaecology, 2019
Tilemachos Kavvadias, Hans Helge Seifert, Jan Ebbing, David Nunez Garcia, Andre Boris Kind
The management of prolapse of the neo-vagina after sex reassignment surgery is a clinical challenge. A literature review reveals only a handful of reports using various surgical techniques, including the fixation of the vaginal cuff to the Denonvilliers fascia, to the Cooper’s, or the sacrospinous ligament, as well as abdominal colpopexy and laparoscopic iliopectineal fixation (Loverro et al. 2002; Frederick and Leach 2004; Condous et al. 2006; Stanojevic et al. 2007; Bucci et al. 2014). Failure of these procedures can lead to a recurrence, which can be frustrating and even more challenging than the primary case, while evidence for the correct management is, in actual fact, completely absent.
Different approaches to the prostate: The upcoming role of a purpose-built single-port robotic system
Published in Arab Journal of Urology, 2018
Jihad Kaouk, Juan Garisto, Riccardo Bertolo
The standard multiport robot-assisted approach was first described by Galfano et al. [16]. The parietal peritoneum is incised at the anterior surface of the Douglas space. The seminal vesicles and the vas deferens are isolated and incised. Denonvilliers’ fascia is separated by the postero-lateral surface of the prostate in an antegrade direction, reaching the prostatic apex so that a completely intrafascial plane is maintained. The bladder neck is isolated and sectioned. In order to evert the mucosa and to easily identify the bladder neck orifice for performing the anastomosis, four short cardinal sutures can be positioned. The anterior surface of the prostate is bluntly isolated from the dorsal venous complex without any incision. The apex isolation is completed, and the urethra is incised, completing the RP. Anastomosis is performed using a running suture starting from the 3 o’clock position. After the anterior sutures into the bladder neck are passed, the catheter is pushed into the bladder and the anastomosis is completed. The final step of the procedure is represented by the closure of the parietal peritoneum at the Douglas space level. Several advantages have been suggested for the Retzius-sparing approach, such as the complete intrafascial dissection, the avoidance of the Santorini plexus and pubourethral ligaments, and a smaller surgical dissection allowing for impressively high potency rate and early return of continence [15,16]. On the other side, the limited space available with such an approach may bring some disadvantages, especially in men with large prostates. Several reports have studied the impact of prostate gland size on the outcomes: Retzius-sparing approach is oncologically and functionally equivalent regardless of the prostate size but is technically demanding for larger prostates [17].