{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:00:17Z","timestamp":1781046017487,"version":"3.54.1"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since robot-assisted laparoscopic prostatectomy (RALP) has nowadays become widely accepted world-wide, there needs to be an agreement on the most efficient surgical techniques. This should be based on the video-anatomy of the prostate and a summary of the actual literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>Using video material taken during RALP-procedures performed by the same surgeon (J.R.), the anatomical details of different surgical techniques and operative steps are shown based on the anatomy of the male pelvis applying the standard nomenclature. This was supplemented by a systematic literature search in PubMed focusing on preservation of continence and minimal rates of positive margins. 3,825 publications could be reduced to 604 articles according to the inclusion criteria (randomized controlled trials, meta-analyses, systematic reviews and clinical studies), When expanding the search to encompass individual operation techniques, we identified 27 relevant articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Crucial surgical details include preserving the levator fascia, the puboprostatic collar, a long urethral stump with protection of the urethral lissosphincter and posteriorly reconstruction of the rectourethralis with the prostatovesical muscle. Fascial preservation for the M. Levator ani results to one year-continence between 78,0 and 98,3%, preservation of the puboprostatic collar and detrusor apron between 95,6 and 100%, maximal functional urethral length between 90,5 and 97,5%. Posterior reconstruction leads to a 3-months continence between 92,3 and 96,9%. Preserving the Retzius` space and thus the total anterior sphincter apparatus results to a one-year continence of 95,8%, however associated with a higher rate of positive surgical margins (14\u201342 vs. 10\u201329%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The increase of knowledge of the video-anatomy of the prostate and surrounding structures allows translation into novel surgical techniques of RALP. Thereby continence rates could be significantly improved including approaches to spare anatomical structures of the sphincter apparatus, such as preservation of the levator fascia, the puboprostatic collar, the urethral lissosphincter, but also reconstructive techniques, such as posterior reconstruction of the vesico-prostatic and recto-urethralis muscle. Demanding techniques, such as the Retzius-sparing approach result to higher continence rates, but are also associated with a higher rate of surgical margins.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1804051","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:53:20Z","timestamp":1778129600000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Demonstration of anatomical and technical details of robotic laparoscopic radical prostatectomy as described in the current literature"],"prefix":"10.3389","volume":"13","author":[{"given":"J.","family":"Rassweiler","sequence":"first","affiliation":[{"name":"Department of Urology and Andrology, Danube Private University","place":["Krems, Austria"]},{"name":"Department of Urology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Sander","sequence":"additional","affiliation":[{"name":"Department of Urology and Andrology, Danube Private University","place":["Krems, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Claire","family":"Rassweiler-Seyfried","sequence":"additional","affiliation":[{"name":"Department of Urology, Klinikum Mannheim, University of Mannheim","place":["Mannheim, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.eururo.2013.09.046","article-title":"EAU Guidelines on prostate cancer part 1: screening, diagnosis, and local treatment with curative intent-update","volume":"65","author":"Heidenreich","year":"2014","journal-title":"Eur Urol"},{"key":"B2","year":""},{"key":"B3","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s00120-022-01927-z","article-title":"Neue S3-leitlinie prostatakarzinom 2021 (version 6.2)\u2014was hat sich beim fortgeschrittenen prostatakarzinom ge\u00e4ndert?","volume":"62","author":"Thomas","year":"2023","journal-title":"Urologie"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.eururo.2009.01.036","article-title":"Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies","volume":"55","author":"Ficarra","year":"2009","journal-title":"Eur Urol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"102098","DOI":"10.1016\/j.suronc.2024.102098","article-title":"Comparative evaluation of continence and potency after radical prostatectomy: robotic vs. Laparoscopic approaches, validating LAP-01 trial","volume":"55","author":"L\u00f3pez-Abad","year":"2024","journal-title":"Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/j.1442-2042.2011.02911.x","article-title":"Anatomical basis for carrying out a state-of-the-art radical prostatectomy","volume":"19","author":"Takenaka","year":"2012","journal-title":"Int J Urol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.eururo.2016.01.026","article-title":"A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update","volume":"70","author":"Walz","year":"2016","journal-title":"Eur Urol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"6780","DOI":"10.3390\/jcm13226780","article-title":"Factors contributing to early recovery of urinary continence following radical prostatectomy: a narrative review","volume":"13","author":"Barakat","year":"2024","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.eururo.2013.01.014","article-title":"ESUT Expert group on laparoscopy proposes uniform terminology during radical prostatectomy. We need to speak the same language","volume":"64","author":"Rassweiler","year":"2013","journal-title":"Eur Urol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1089\/end.2004.18.593","article-title":"Transperitoneal laparoscopic radical prostatectomy: ascending technique","volume":"18","author":"Rassweiler","year":"2004","journal-title":"J Endourol"},{"key":"B11","first-page":"1094","article-title":"Laparoscopic radical prostatectomy","volume-title":"Smith`s Textbook of Endourology, 3rd Edition, Vol. 2","author":"Rassweiler","year":"2010"},{"key":"B12","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/978-3-319-33231-4_53","article-title":"Transperitoneal ascending laparoscopic radical prostatectomy","volume-title":"Operative Atlas of Laparoscopic and Reconstructive Urology","author":"Rassweiler","year":"2017"},{"key":"B13","volume-title":"Terminologia Anatomia, International Anatomical Terminology","author":"Whitmore","year":"1998"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1016\/S0022-5347(01)62202-X","article-title":"Anatomic radical prostatectomy: evolution of the surgical technique","volume":"160","author":"Walsh","year":"1998","journal-title":"J Urol"},{"key":"B15","first-page":"701","article-title":"Anatomic considerations in radical prostatectomy","volume-title":"Prostate Cancer. Principles and Practice","author":"Myers","year":"2006"},{"key":"B16","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.eururo.2006.11.012","article-title":"Anatomical landmarks of radical prostatectomy","volume":"51","author":"Stolzenburg","year":"2007","journal-title":"Eur Urol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.eururo.2005.10.008","article-title":"Open retropubic nerve-sparing radical prostatectomy","volume":"49","author":"Graefen","year":"2006","journal-title":"Eur Urol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.eururo.2009.11.009","article-title":"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","volume":"57","author":"Walz","year":"2010","journal-title":"Eur Urol"},{"key":"B19","first-page":"23","article-title":"Proposition et observation d\u00b4anatomie, de physiologie et de pathologie","volume":"258","author":"Denonvillers","year":"1837","journal-title":"These de \u013aEcole de Medicine"},{"key":"B20","first-page":"334","article-title":"Morphology and function of vesico-prostato-urethral musculature","author":"Gil-Vernet","year":"1968","journal-title":"Treviso, Edizioni di Urologia"},{"key":"B21","first-page":"173","article-title":"De virorum naturalibus","volume-title":"Observationes Anatomicae","author":"Santorini","year":"1724"},{"key":"B22","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.eururo.2006.07.007","article-title":"Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy: anatomic basis and preliminary outcomes","volume":"51","author":"Takenaka","year":"2007","journal-title":"Eur Urol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1097\/00000478-198808000-00003","article-title":"Normal histology of the prostate","volume":"12","author":"McNeal","year":"1988","journal-title":"Am J Surg Pathol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1159\/000282596","article-title":"Dieterich F: a new theory of micturation and urinary continence based on histomorphologic studies part 2: the musculus sphincter vesicae: continence or sexual function","volume":"52","author":"Dorschner","year":"1994","journal-title":"Urol Int"},{"key":"B25","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/j.1464-410X.1981.tb03125.x","article-title":"A comparative study of the human external sphincter and periurethral levator ani muscles","volume":"53","author":"Gosling","year":"1981","journal-title":"Br J Urol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/S0090-4295(96)00497-9","article-title":"Neuroanatomy of the male rhabdosphincter","volume":"49","author":"Hollabaugh","year":"1997","journal-title":"Urology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"151","DOI":"10.2217\/14750708.6.2.151","article-title":"Anatomy of urinary continence and neurogenic incontinence","volume":"6","author":"Golomb","year":"2009","journal-title":"Therapy"},{"key":"B28","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1308\/003588408X321611","article-title":"Pelvic fasciae in urology","volume":"90","author":"Raychaudhuri","year":"2008","journal-title":"Ann R Coll Surg Engl"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1016\/j.juro.2008.01.010","article-title":"The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate","volume":"179","author":"Koraitim","year":"2008","journal-title":"J Urol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1289765","DOI":"10.3389\/fsurg.2023.1289765","article-title":"Surgical techniques to preserve continence after robot-assisted radical prostatectomy","volume":"10","author":"Katsimperis","year":"2023","journal-title":"Front Surg"},{"key":"B31","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/iju.14228","article-title":"Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: anatomical landmarks to achieve early urinary continence","volume":"27","author":"Kataoka","year":"2020","journal-title":"Int J Urol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"14126","DOI":"10.1038\/s41598-023-41083-8","article-title":"Role of puboperinealis and rectourethralis muscles as a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy","volume":"13","author":"Hata","year":"2023","journal-title":"Sci Rep"},{"key":"B33","first-page":"181","article-title":"Post-radical prostatectomy incontinence: etiology and prevention","volume":"16","author":"Hoyland","year":"2014","journal-title":"Rev Urol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1177\/1756287218813787","article-title":"Anatomical, surgical and technical factors influencing continence after radical prostatectomy","volume":"11","author":"Arroyo","year":"2019","journal-title":"Ther Adv Urol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"581","DOI":"10.5534\/wjmh.200114","article-title":"How to prevent and manage post-prostatectomy incontinence: a review","volume":"39","author":"Schifano","year":"2021","journal-title":"World J Mens Health"},{"key":"B36","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.eururo.2015.07.037","article-title":"Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy","volume":"69","author":"Michl","year":"2016","journal-title":"Eur Urol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1038\/s41391-019-0173-y","article-title":"Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy","volume":"23","author":"Nunez Bragayrac","year":"2020","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"B38","first-page":"146","article-title":"The association of length of the resected membranous urethra with urinary incontinence after radical prostatectomy","volume":"17","author":"Kohjimoto","year":"2020","journal-title":"Urol J"},{"key":"B39","first-page":"177","article-title":"Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy","volume":"17","author":"Hoeh","year":"2023","journal-title":"J Robot Surg"},{"key":"B40","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/iju.14228","article-title":"Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: anatomical landmarks to achieve early urinary continence","volume":"27","author":"Laucirica","year":"2020","journal-title":"Int J Urol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s11934-017-0717-4","article-title":"Surgical techniques to optimize early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer","volume":"18","author":"Sridhar","year":"2017","journal-title":"Curr Urol Rep"},{"key":"B42","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.eururo.2006.12.022","article-title":"A new postoperative predictor of time to urinary continence after laparoscopic radical prostatectomy: the urine loss ratio","volume":"52","author":"Ates","year":"2007","journal-title":"Eur Urol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"639","DOI":"10.4111\/icu.20220235","article-title":"Modified apical dissection improves early continence in robot-assisted laparoscopic radical prostatectomy: comparative study between modified apical dissection and anterior suspension stitch","volume":"63","author":"Kang","year":"2022","journal-title":"Investig Clin Urol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e2022","DOI":"10.4293\/JSLS.2022.00077","article-title":"Ultrapreservation in robotic assisted radical prostatectomy provides early continence recovery","volume":"27","author":"Kucuk","year":"2023","journal-title":"JSLS"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1528142","DOI":"10.1155\/2019\/1528142","article-title":"Detrusorrhaphy during robot-assisted radical prostatectomy:early recovery of urinary continence and surgical technique","volume":"8","author":"Shin","year":"2019","journal-title":"BioMed Research Intern"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1089\/end.2020.0379","article-title":"Subsphincteric anastomosis during laparoscopic robot-assisted radical prostatectomy and its positive impact on continence recovery","volume":"34","author":"Almeras","year":"2020","journal-title":"J Endourol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"186","DOI":"10.4081\/aiua.2017.3.186","article-title":"The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; results from a high-volume center","volume":"89","author":"Gozen","year":"2017","journal-title":"Arch Ital Urol Androl"},{"key":"B48","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1089\/end.2014.0459","article-title":"A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: preliminary results","volume":"29","author":"Tunc","year":"2015","journal-title":"J Endourol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"2068","DOI":"10.3390\/jcm8122068","article-title":"Effect of bladder neck preservation on long-term urinary continence after robot-assisted laparoscopic prostatectomy: a systematic review and meta-analysis","volume":"8","author":"Kim","year":"2019","journal-title":"J Clin Med"},{"key":"B50","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1111\/j.1464-410X.2009.08751.x","article-title":"Anatomical reconstruction of the rhabdosphincter after radical prostatectomy","volume":"104","author":"Rocco","year":"2009","journal-title":"BJU Int"},{"key":"B51","doi-asserted-by":"publisher","first-page":"274","DOI":"10.4081\/aiua.2021.3.274","article-title":"Reconstruction of the Denonvilliers\u2019 fascia and posterior ligament of the external urethral sphincter: assessment of its effect on urinary continence after laparoscopic radical prostatectomy","volume":"93","author":"Passos","year":"2021","journal-title":"Arch Ital Urol Androl"},{"key":"B52","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s11255-023-03766-z","article-title":"A matched-analysis on short-term and long-term (up to 5 years of follow-up) urinary incontinence outcomes after robot-assisted radical prostatectomy with and without anterior and posterior reconstruction: data on 1358 patients","volume":"56","author":"Rinaldi","year":"2024","journal-title":"Int Urol Nephrol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"230","DOI":"10.23736\/S0393-2249.18.03260-5","article-title":"Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy: our initial experience","volume":"71","author":"Puliatti","year":"2019","journal-title":"Minerva Urol Nefrol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.eururo.2010.06.008","article-title":"A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery","volume":"58","author":"Galfano","year":"2010","journal-title":"Eur Urol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1016\/j.asjsur.2021.09.013","article-title":"A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: evidence of continence advantage on the early learning curve","volume":"45","author":"Yee","year":"2022","journal-title":"Asian J Surg"},{"key":"B56","first-page":"541","article-title":"Retzius-sparing robotic-assisted prostatectomy: technical challenges for surgeons and key prospective refinements","volume":"15","author":"Ferretti","year":"2023","journal-title":"Res Rep Urol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1016\/j.euf.2021.08.003","article-title":"Retzius sparing radical prostatectomy versus robot-assisted radical prostatectomy: which technique is more beneficial for prostate cancer patients (MASTER study)? A systematic review and meta-analysis","volume":"8","author":"Barakat","year":"2022","journal-title":"Eur Urol Focus"},{"key":"B58","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1016\/j.juro.2009.11.011","article-title":"Post-prostatectomy urinary incontinence: a confluence of 3 factors","volume":"183","author":"Loughlin","year":"2010","journal-title":"J Urol"},{"key":"B59","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/S0022-5347(01)65334-5","article-title":"Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy","volume":"157","author":"Hammerer","year":"1997","journal-title":"J Urol"},{"key":"B60","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.eururo.2014.10.020","article-title":"Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis","volume":"68","author":"Reeves","year":"2015","journal-title":"Eur Urol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.euo.2023.07.009","article-title":"Peritoneal flap for lymphocele prophylaxis following robotic-assisted radical prostatectomy with lymph node dissection: the randomised controlled phase 3 PELYCAN trial","volume":"7","author":"Neuberger","year":"2024","journal-title":"Eur Urol Oncol"},{"key":"B62","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.eururo.2020.09.044","article-title":"Hood technique for robotic radical prostatectomy-preserving periurethral anatomical structures in the space of retzius and sparing the pouch of douglas, enabling early return of continence without compromising surgical margin rates","volume":"80","author":"Wagaskar","year":"2021","journal-title":"Eur Urol"},{"key":"B63","author":"Rassweiler","year":"2025"},{"key":"B64","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.eururo.2025.06.002","article-title":"Analysis of the current surgical anatomical knowledge of radical prostatectomy: an updated review","volume":"89","author":"Mandel","year":"2026","journal-title":"Eur Urol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1804051\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:53:33Z","timestamp":1778129613000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1804051\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":64,"alternative-id":["10.3389\/fsurg.2026.1804051"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1804051","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"article-number":"1804051"}}