Neuro- and Fascial Anatomy in the Male Pelvis for Robotic Radical Prostatectomy

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related deaths in men in the US [Parker et al., 1997]. In the Prostate Specific Antigen (PSA) era, minimally invasive and nerve-sparing radical surgery for prostate cancer, e.g., conventional and robot-associated laparoscopic prostatectomy, is widely performed throughout the country. Robotic prostatectomy started in 2000 [Menon et al., 2004], and it is estimated that 33,500 cases were performed during 2006. Robotic prostatectomy is increasing rapidly, and is becoming an important option for the management of localized prostate cancer. The da Vinci Robot® (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed instruments facilitated the performance of radical prostatectomy with consideration of the pelvic anatomy (Figure 1). It is possible to view almost all pelvic anatomic structures during robotic prostatectomy. This enables the surgeon, in theory, to perform the operation with respect to anatomic findings using the multi-jointed instruments, compared with conventional for laparoscopic radical prostatectomy.