Widefield dissection radical perineal prostatectomy

In patients considered at high risk for extracapsular disease, the procedure may be extended to encompass the lateral pelvic fascia with the removed prostate. Wide-field radical perineal prostatectomy always results in sacrifice of the neurovascular bundles because the margin of resection always includes the periprostatic fascia. The prostate is exposed as described. However, after the rectum is displaced posteriorly, a surgical plane is developed between the posterior layers of Denonvillier's fascia - the anterior rectal surface posteriorly and the levator musculature anteriorly. The prostate remains surrounded by the periprostatic lateral pelvic fascia. All fibrovascular pedicles are divided as far distant from the prostate as possible. The seminal vesicles are dissected as described, but clipped and dissected at such a level to include the neurovascular bundle at that level. Additionally, wider margins of the bladder neck may be taken to achieve negative margins followed by reconstruction as described.

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