Volume 53, Issue 5, Pages 931-940 (May 2008) Intrafascial Nerve-Sparing Endoscopic Extraperitoneal Radical Prostatectomy  Jens-Uwe Stolzenburg, Robert Rabenalt, Minh Do, Thilo Schwalenberg, Mathias Winkler, Anja Dietel, Evangelos Liatsikos  European Urology  Volume 53, Issue 5, Pages 931-940 (May 2008) DOI: 10.1016/j.eururo.2007.11.047 Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 1 Trocar placement for intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy (1–4=sequence of placement of trocars). Notice the course of the epigastric vessels on both sides. Trocar no. 2 should be inserted medially, and trocar no. 3 should be inserted laterally to the epigastric vasculature. European Urology 2008 53, 931-940DOI: (10.1016/j.eururo.2007.11.047) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 2 Incision of the superficial fascia overlaying the prostate ventrally (A). Anterior bladder-neck dissection (B and C) and lateral bladder-neck dissection (C). pb=pubic bone; pl=puboprostatic ligaments; p=prostate; ef=endopelvic fascia; bl=bladder; bn=bladder neck; c=catheter. European Urology 2008 53, 931-940DOI: (10.1016/j.eururo.2007.11.047) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 3 Posterior bladder-neck dissection and dissection of the vas deferentia (A), stripping Denonvilliers fascia from the prostatic capsule (B and C), and dissection of the posterior part of the prostate toward the apex (D). p=prostate; bl=bladder; Dv=Denonvilliers fascia; ef=endopelvic fascia. European Urology 2008 53, 931-940DOI: (10.1016/j.eururo.2007.11.047) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 4 Prostatic pedicle dissection and sparing of the neurovascular bundles (A–C), ligation of Santorini plexus (D). p=prostate; pp=prostatic pedicle; ef=endopelvic fascia; nbv=neurovascular bundle; Sp=Santorini plexus; pl=puboprostatic ligaments; r=rectum. European Urology 2008 53, 931-940DOI: (10.1016/j.eururo.2007.11.047) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 5 Apical dissection. Dissection of the anterior urethra is performed from laterally to medially (A) and in three steps (B): step 1: dissection of Santorini plexus; step 2: dissection of the apex of the prostate and the urethra with the external sphincter (star), step 3: dissection of the inner smooth muscular layer of the urethra (dot). Urethrovesical anastomosis (interrupted sutures): sequence of stitches (external numbers). (C) The internal numbers show the site of each stitch clockwise. (D) Placement of drainage. p=prostate; u=urethra; nvb=neurovascular bundle; Sp=Santorini plexus; pl=puboprostatic ligaments; bl=bladder. European Urology 2008 53, 931-940DOI: (10.1016/j.eururo.2007.11.047) Copyright © 2007 European Association of Urology Terms and Conditions