Arch of Denonvilliers'fascia as an anatomical marker in prevention of rectal injury during laparoscopic radical prostatectomy
Objective:The fusion of Denonvilliers'fascia and prostatic capsule presents a transverse eminence termed Arch of Denonvilliers'fascia.The role of Denonvilliers'fascia arch as an anatomical marker in the preven-tion of rectal injury during laparoscopic radical prostatectomy is investigated.Methods:From January 2018 to No-vember 2021,210 prostate cancer cases with TNM pathological stage T2a-T4 successfully underwent laparo-scopic radical prostatectomy through extraperitoneal approach.The previous 101 cases(control group)were opera-ted by extrafascial method.The latter 109 cases were in the experimental group.Denonvilliers'fascia was pushed to the caudal,close to the seminal vesicle and vas deferens,until pushing motionless.Namely to the in-plane ejac-ulation,here Denonvilliers'fascia forms a transverse fold uplift named Denonvilliers'fascia arch.Denonvilliers'fas-cia was cut open in this arch belows lightly,entering the fat layer before rectum.Again pulling the fat before rec-tum,and separating the prostate closely,entered the gap between Denonvilliers'fascia and prostate capsule.Then,a blunt dissection to the tip of the prostate and lateral vascular pedicle was performed.It's called intrafascial method.Later operation steps were similar to the control group.The operative time,blood loss volume,rectal in-jury and urine leakage cases were compared between two groups.Results:All the 210 operations were successfully performed.The mean operating time,blood loss volume,rectal injury cases,urine leakage cases in control group and experimental group were(210.0±19.6)min and(120.0±18.7)min,(110.0±9.7)mL and(50.0±4.5)mL,6 cases versus 1 case and 4 cases versus 1 case respectively.Among the 6 cases of rectal injuries in the con-trol group,4 cases were found intraoperatively and were sutured in two-layered way and healed.Other 2 cases were found postoperatively with cysto-rectal fistula.Colostomy was performed and the fistula healed after indwell-ing catheter for 6 or 8 months.One case in the experimental group who was found rectal injuries intraoperatively was sutured in two-layered way and healed.Three cases of rectal injuries located at Denonvilliers'fascia,2 cases at the base of the prostate,and 2 cases at the tip of the prostate.A significant higher incidence of rectal injury was found in the control group than that in the experimental group(x2=4.11,P=0.04).Conclusion:The Denonvilli-ers'fascia arch can be used as an anatomical marker for incision transverse Denonvilliers'fascia to reduce the inci-dence of rectal injury during laparoscopic radical prostatectomy.
Denonvilliers'fasciaprostate cancerradical prostatectomyanatomyarch of Denonvilliers'fascia
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