Endopelvic Fascia Preservation Nerve Sparing RARP

Endopelvic fascia preservation nerve sparing RARP. Kazuhiro Matsumoto, M.D. Ph.D.Department of Urology, Keio University School of Medicine. We present the endopelvic fascia preservation nerve sparing RARP, using new surgical robot *brand hidden*. This made-in-Japan surgical robot *brand hidden* consists of operation unit, surgical cockpit, and monitor cart. The biggest difference between the ‘brand hidden’ and ‘brand hidden’ is that ‘brand hidden’ arm doesn’t grip the trocar. The arm just grips the end of the instrument. Since there is no need to dock the arm and trocar, the area around the trocar is clutter-free. A workspace for the assistant doctor can be secured widely, leading to improved operability. Since there is no ‘remote center’, ‘hinotori’ can handle close objects without movement restrictions. We present the case who received the conventional nerve sparing for the cancer side (left), and endopelvic fascia preservation nerve sparing for the cancer-free side (right). On the left side, the endopelvic fascia was cut and prostate lateral side was opened. On the right side, endopelvic fascia was not opened. After the bladder and prostate are divided, the anterolateral superficial vascular layer is cut to directly reach the prostate surface on the right side. The endopelvic fascia preservation nerve sparing technique enables us to remove the prostate with pelvic muscles completely covered by endopelvic fascia and vascular layers. Our retrospective analyses on 66 RARP cases performed by ‘brand hidden’ demonstrated a tendency that endopelvic fascia preservation nerve sparing achieved the better urinary continence 30 days after surgery. We conclude that delicate and safe RARP can be performed by ‘brand hidden’, and endopelvic fascia preservation nerve sparing technique is effective for urinary continence.