Real-time transrectal ultrasound: An adjunct to nervesparing laparoscopic radical prostatectomy

The authors of this study report that real-time transrectal ultrasound (TRUS) can visualize prostate / peri prostatic anatomy and provide intraoperative navigation during nerve-sparing laparoscopic radical prostatectomy (LRP). Gray-scale ultrasound (7.5 MHz) and power Doppler ultrasound were used in 77 consecutive men for transperitoneal LRP. Real-time TRUS monitoring was performed preoperatively, intraoperatively and immediately postoperatively. Emphasis was placed on identifying the neurovascular bundles, defining the prostate apex contour and evaluating the location and extent of any hypoechoeic cancer nodules. Intraoperative TRUS navigation appeared to be helpful for certain specific technical aspects of LRP, including 1) the identification of hypoechoeic prostate cancer nodules 2) precision during lateral pedicle transaction and neurovascular bundle release 3) calibrated, wider dissection at the site of suspected extra-capsular extension of cancer nodules to achieve negative margins 4) tailored dissection according to the individual prostate apex and (5) facilitation of posterior bladder neck transaction for the novice. Real-time TRUS monitoring of the location of the laparoscopic scissors tip (hyperechoic spot) in regard to the safe dissection plane at the concerned anatomical site was feasible. Blood flow in the neurovascular bundles before, during and after nerve-sparing LRP was documented.