Optical Coherence Tomography of Cavernous Nerves: A Step Toward Real-Time Intraoperative Imaging During Nerve-Sparing Radical Prostatectomy
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摘要
A total of 12 dogs were divided into 4 groups based on the type of energy source used for hemostasis during unilateral dissection of the NVB. The groups included conventional dissection with suture ligatures (group 1), monopolar (group 2) or bipolar (group 3) electrosurgery and ultrasonic shears (group 4). The contralateral NVB was left undissected as a control. Erectile function was assessed acutely and after 2 weeks of survival by measuring peak intracavernous pressures in response to cavernous nerve stimulation.

Results

Following conventional techniques of nerve sparing, the erectile response to nerve stimulation was unaffected. In contrast, the use of energy sources in proximity to the NVB during nerve preservation was associated with a substantial decrease in erectile response both acutely (74%to 91%decrease compared to controls) and after 2 weeks (93%to 96%decrease).

Conclusions

In the chronic canine model, use of hemostatic energy sources in proximity to the prostate during dissection of the neurovascular bundle is associated with a significantly decreased erectile response to cavernous nerve stimulation.


m/science?_ob=MImg&_imagekey=B7XMT-4HFTKG9-T-1&_cdi=29679&_user=10&_orig=article&_coverDate=10%2F31%2F2004&_sk=998279995.7998&view=c&wchp=dGLzVlz-zSkWb&md5=31fc540347892af31427c586a8f84577&ie=/sdarticle.pdf">mg name="pdf" style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (539 K)
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mg src="/scidirimg/bullet_square.gif" alt="">mt=high&_coverDate=05%2F31%2F2008&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3c329564ed6e41fe1ee452282d4ad640" onMouseOver="InfoBubble.show('infobubble_2','mlktLink_2')" onMouseOut="InfoBubble.timeout()">Anatomical and Electrophysiological Assessment of the C...
The Journal of Urology
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mg border=0 src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> m/science?_ob=ArticleURL&_udi=B7XMT-4S3G9Y6-3&_user=10&_coverDate=05%2F31%2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=29679&_sort=v&_docanchor=&view=c&_ct=1010&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=617c1a5b322938e8ccf6c123ca1d36b3">Anatomical and Electrophysiological Assessment of the Canine Periprostatic Neurovascular Anatomy: Perspectives as a Nerve Sparing Radical Prostatectomy Model
The Journal of Urology, Volume 179, Issue 5, May 2008, Pages 2025-2029
Troy Richard John Gianduzzo, Jose R. Colombo, Ehab El-Gabry, Georges-Pascal Haber, Inderbir S. Gill

Abstract
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Purpose

Although the dog is often used as a radical prostatectomy model, precise descriptions of canine prostate and neurovascular bundle anatomy are lacking. We describe canine prostate and neurovascular bundle anatomical and electrophysiological characteristics.

Materials and Methods

The canine prostate and pelvic neurovascular structures were dissected in 6 canine cadavers and 12 anesthetized dogs. Pelvic plexus branches were stimulated using a CaverMap® probe and peak intracavernous pressure responses were recorded as a percent of mean arterial pressure.

Results

The canine pelvic plexus lies 5 to 10 mm lateral to the prostate. It is supplied by the hypogastric nerve cranially and the pelvic nerve laterally. The neurovascular bundles course distal from the pelvic plexus along the posterolateral aspect of the prostate, including a dominant cavernous nerve along its lateral aspect. CaverMap stimulation of the efferent branches of the pelvic plexus confirmed their roles in tumescence. Histology revealed extensive neurovascular tissue along the posterolateral aspect of the prostate beneath the periprostatic fascia. Notable differences to human anatomy were the absence of seminal vesicles, the lateral positions of the pelvic plexus, the dominant cavernous nerve and the circumferential urethral distribution of the cavernous nerves.

Conclusions

Canine neurovascular anatomy resembles that of humans and it is a suitable model in which to assess prostatectomy related erectile dysfunction. However, there are key differences in neurovascular relationships that must be considered when the canine prostate is used as a radical prostatectomy model.


m/science?_ob=MImg&_imagekey=B7XMT-4S3G9Y6-3-C&_cdi=29679&_user=10&_orig=article&_coverDate=05%2F31%2F2008&_sk=998209994&view=c&wchp=dGLzVlz-zSkWb&md5=3630081d218ca3133ea01363d48be565&ie=/sdarticle.pdf">mg name="pdf" style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (1173 K)
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mg src="/scidirimg/bullet_square.gif" alt="">mt=high&_coverDate=07%2F31%2F2004&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7d97590e9e04ae1bcd8c5cdc157a04f1" onMouseOver="InfoBubble.show('infobubble_3','mlktLink_3')" onMouseOut="InfoBubble.timeout()">REAL-TIME TRANSRECTAL ULTRASONOGRAPHY DURING LAPAROSCOP...
The Journal of Urology
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mg border=0 src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> m/science?_ob=ArticleURL&_udi=B7XMT-4HGS96N-Y&_user=10&_coverDate=07%2F31%2F2004&_rdoc=1&_fmt=high&_orig=article&_cdi=29679&_sort=v&_docanchor=&view=c&_ct=1010&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=58cb18473a3c18fa7ad0f6455973d83c">REAL-TIME TRANSRECTAL ULTRASONOGRAPHY DURING LAPAROSCOPIC RADICAL PROSTATECTOMY
The Journal of Urology, Volume 172, Issue 1, July 2004, Pages 112-118
OSAMU UKIMURA, INDERBIR S. GILL, MIHIR M. DESAI, ANDREW P. STEINBERG, METE KILCILER, CHRISTOPHER S. NG, SIDNEY C. ABREU, MASSIMILIANO SPALIVIERO, ANUP P. RAMANI, JIHAD H. KAOUK, AKIHIRO KAWAUCHI, TSUNEHARU MIKI

Abstract
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ABSTRACT

Purpose:

We describe the technical aspects of real-time transrectal ultrasound (TRUS) monitoring and guidance during laparoscopic radical prostatectomy (LRP). Furthermore, we describe the TRUS visualized anatomy of periprostatic structures during LRP.

Materials and Methods:

In 25 consecutive patients undergoing transperitoneal LRP, baseline preoperative, real-time intraoperative and immediate postoperative TRUS evaluations were performed. To define periprostatic anatomy precisely TRUS measurements were obtained with specific reference to the neurovascular bundle (NVB), prostate apex, membranous urethra, bladder neck, rectal wall and any cancer nodule. Conventional gray scale, power Doppler, harmonic imaging and 3-dimensional ultrasound functions were used.

Results:

Real-time TRUS navigation facilitated 3 technical aspects of LRP. 1) It identified the correct plane between the posterior bladder neck and prostate base, allowing quick laparoscopic identification of the vasa and seminal vesicles. 2) It identified the occasional, difficult to see distal protrusion of the prostate apex posterior to the membranous urethra, thus enhancing apical dissection with negative margins. 3) It provided visualization of any hypoechoic nodule abutting the prostate capsule, alerting the laparoscopic surgeon to perform wide dissection at that location. TRUS measured various anatomical parameters including i) the mean distance ±SD between the NVB and the lateral edge of the prostate a) at apex (1.9 ± 0.9 mm), b) base (2.5 ± 0.8 mm) and c) tip of seminal vesicle (4.0 ± 1.6 mm), ii) the dimensions of the NVB a) before (4.5 × 3.9 mm), b) after (4.2 × 3.6 mm) nerve sparing LRP and c) after nonnerve sparing LRP (0.9 × 0.9 mm), iii) arterial blood flow resistive index within NVB a) before (0.83 ± 0.04), b) after (0.84 ± 0.03) nerve sparing LRP and c) after nonnerve sparing LRP (0), iv) and the length of membranous urethra a) before (12.2 ± 1.1 mm) and b) after (11.7 ± 1.0 mm) surgery. Focal distortion of the prostate surface by an exophytic nodule was visualized on TRUS in 3 patients, necessitating ipsilateral nerve resection at LRP and contributing to negative surgical margins.

Conclusions:

This initial experience suggests that real-time intraoperative TRUS guidance may enhance anatomical performance of LRP. This improved understanding of periprostatic anatomy has the potential to improve functional and oncological outcomes. Such corroboration is awaited.


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