臨床泌尿器科67巻5号

2013年04月発行

特集 ロボット支援前立腺全摘除術

各論④　神経温存―RALPで注意すべき解剖学的ポイントと手術操作

著者： 森實修一¹ 瀬島健裕¹ 武中篤¹

所属機関： ¹鳥取大学医学部器官制御外科学講座腎泌尿器学分野

ページ範囲：P.321 - P.327

要旨　本邦でも手術支援ロボットda Vinci Surgical Systemが導入されて以降，前立腺癌に対する手術手技は大きな変化を遂げた。特に，拡大明視野で繊細な手術操作が行える利点を生かした神経温存術式は，開放手術と比較してその発展は目覚ましい。患者個々の前立腺癌の悪性度，占拠部位，術前勃起機能に応じて神経温存術式の選択が可能となり，個々の症例に応じた手術操作を行うことで，制癌効果および勃起機能の温存が期待される。

参考文献

1）Takenaka A, Murakami G, Soga H, et al：Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy. J Urol 172：1032-1035, 2004

2）Menon M, Kaul S, Bhandari A, et al：Potency following robotic radical prostatectomy：a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol 174：2291-2296, discussion 2296, 2005

3）Stolzenburg JU, Kallidonis P, Do M, et al：A comparison of outcomes for interfascial and intrafascial nerve-sparing radical prostatectomy. Urology 76：743-748, 2010

4）Nielsen ME, Schaeffer EM, Marschke P, et al：High anterior release of the levator fascia improves sexual function following open radical retropubic prostatectomy. J Urol 180：2557-2564；discussion 2564, 2008

5）van der Poel HG and de Blok W：Role of extent of fascia preservation and erectile function after robot-assisted laparoscopic prostatectomy. Urology 73：816-821, 2009

6）van der Poel HG, de Blok W, Joshi N, et al：Preservation of lateral prostatic fascia is associated with urine continence after robotic-assisted prostatectomy. Eur Urol 55：892-900, 2009

7）Lunacek A, Schwentner C, Fritsch H, et al：Anatomical radical retropubic prostatectomy：‘curtain dissection’of the neurovascular bundle. BJU Int 95：1226-1231, 2005

8）Takenaka A, Leung RA, Fujisawa M, et al：Anatomy of autonomic nerve component in the male pelvis：the new concept from a perspective for robotic nerve sparing radical prostatectomy. World J Urol 24：136-143, 2006

9）Hisasue S, Hashimoto K, Kobayashi K, et al：Baseline erectile function alters the cavernous nerve quantity and distribution around the prostate. J Urol 184：2062-2067, 2010

10）Ganzer R, Blana A, Gaumann A, et al：Topographical anatomy of periprostatic and capsular nerves：quantification and computerised planimetry. Eur Urol 54：353-360, 2008

11）Alsaid B, Karam I, Bessede T, et al：Tridimensional computer-assisted anatomic dissection of posterolateral prostatic neurovascular bundles. Eur Urol 58：281-287, 2010

12）Kaiho Y, Nakagawa H, Saito H, et al：Nerves at the ventral prostatic capsule contribute to erectile function：initial electrophysiological assessment in humans. Eur Urol 55：148-154, 2009

13）Takenaka A, Soga H, Hinata N, et al：Classification of the distribution of cavernous nerve fibers around the prostate by intraoperative electrical stimulation during laparoscopic radical prostatectomy. Int J Impot Res 23：56-61, 2011

14）Costello AJ, Dowdle BW, Namdarian B, et al：Immunohistochemical study of the cavernous nerves in the periprostatic region. BJU Int 107：1210-1215, 2011

15）Walz J, Burnett AL, Costello AJ, et al：A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 57：179-192, 2010

16）Tewari AK, Srivastava A, Huang MW, et al：Anatomical grades of nerve sparing：a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy（RARP）. BJU Int 108：984-992, 2011

17）Patel VR, Schatloff O, Chauhan S, et al：The role of the prostatic vasculature as a landmark for nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61：571-576, 2012

18）Schatloff O, Chauhan S, Sivaraman A, et al：Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61：796-802, 2012

19）Poore RE, McCullough DL and Jarow JP：Puboprostatic ligament sparing improves urinary continence after radical retropubic prostatectomy. Urology 51：67-72, 1998

20）Takenaka A, Tewari AK, Leung RA, et al：Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy：anatomic basis and preliminary outcomes. Eur Urol 51：433-440；discussion 440, 2007

21）Soga H, Takenaka A, Murakami G, et al：Topographical relationship between urethral rhabdosphincter and rectourethralis muscle：a better understanding of the apical dissection and the posterior stitches in radical prostatectomy. Int J Urol 15：729-732, 2008

22）Kiyoshima K, Yokomizo A, Yoshida T, et al：Anatomical features of periprostatic tissue and its surroundings：a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34：463-468, 2004

23）Takenaka A and Tewari AK：Anatomical basis for carrying out a state-of-the-art radical prostatectomy. Int J Urol 19：7-19, 2012