#317 Endopelvic fascia preservation nerve sparing RARP Dr. Kazuhiro Matsumoto

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: 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 ‘hinotori’. This made-in-Japan surgical robot ‘hinotori’ consists of operation unit, surgical cockpit, and monitor cart. The biggest difference between the ‘daVinci’ and ‘hinotori’ is that ‘hinotori’ 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 ‘hinotori’ 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 ‘hinotori’, and endopelvic fascia preservation nerve sparing technique is effective for urinary continence.

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