Prostate cancer treatment has seen remarkable advancements in recent years, with robotic-assisted surgery leading the way in improving outcomes for patients. Among the latest and most sophisticated techniques is the Retzius-sparing bilateral nerve-preserving radical prostatectomy, a procedure that offers significant advantages in preserving quality of life while effectively treating prostate cancer.
What Is the Retzius Space, and Why Does It Matter?
The Retzius space is located at the front of the prostate, between the bladder and the pubic bone. Traditional prostatectomy techniques involve entering this space to access the prostate. While effective in removing the cancer, this approach can disrupt critical structures involved in urinary control and sexual function, such as the bladder neck, urethral sphincter, and supportive pelvic tissues.
The Retzius-sparing technique takes a different route. Instead of accessing the prostate through the front, the surgeon approaches from behind the prostate, preserving the Retzius space. This innovative approach minimizes disruption to the structures that play a key role in continence and erections.
Advantages of Retzius-Sparing Prostatectomy
This technique offers several important benefits compared to standard approaches:
1. Better Functional Outcomes:
- Continence: By preserving the Retzius space, patients typically regain urinary control much faster, often within days or weeks after surgery.
- Erections: The nerve-preserving approach protects the delicate neurovascular bundles responsible for erections, significantly improving the chances of maintaining sexual function.
2. Improved Post-Operative Comfort:
Instead of the traditional urethral catheter, which passes through the penis and can be uncomfortable, a suprapubic catheter is used. This catheter is placed through the lower abdomen, avoiding discomfort and making recovery more manageable.
What Is Nerve Preservation?
Nerve preservation is a key part of this procedure. The prostate is surrounded by bundles of nerves that control erections. During surgery, these nerves can be damaged if not carefully protected. In a bilateral nerve-preserving prostatectomy, the surgeon meticulously spares these nerves on both sides of the prostate, enhancing the likelihood of maintaining sexual function after surgery. This is especially important for patients with early-stage cancer confined to the prostate.
How Does Robotic Surgery Enhance This Technique?
The use of the da Vinci surgical robot enhances the precision and success of Retzius-sparing prostatectomy. The robot’s high-definition 3D camera and finely controlled instruments allow for unparalleled accuracy, ensuring that critical structures are preserved while the cancer is effectively removed.
As one of the highest-volume surgeons in Europe performing Retzius-sparing prostatectomy, I have been recognized by Intuitive Surgical, the company behind the da Vinci robot, as a Key Opinion Leader for this technique. This recognition highlights not only my expertise but also the growing global interest in this advanced approach.
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