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Page 6 of 18 Thinagaran et al. Mini-invasive Surg 2021;5:46 https://dx.doi.org/10.20517/2574-1225.2021.53

Figure 5. Posterior dissection, with athermic dissection of the body of the left seminal vesicle.

Figure 6. Post dissection, with incision of Denonvillier’s fascia, and further dissection towards the pelvic floor close to the undersurface
of the prostate. Fat is left on the anterior surface of the rectum to reduce the risk of rectal injury.

The vasa are then divided and the SVs dissected, avoiding cautery and using clips to divide vessels, to avoid
injury to the cell bodies of the pelvic plexus. Once Denonvillier’s fascia is exposed, this is divided and the
plane posterior to the prostate is opened, continuing down to the pelvic floor. Preserving the fat anterior to
the rectum helps to prevent rectal injury.

Lateral rectal space
Next the peritoneum lateral to the umbilical ligaments is incised, and retzius space is opened down to the
pelvic floor, revealing the endopelvic fascia. The bladder is still attached by the urachus to the anterior
abdominal wall and is elevated and put under traction by the fourth arm. Coming back to the lateral pedicle,
the superior vesical artery is isolated, and can be divided between Hem-o-lok® clips or by LigaSure™
instrument. The anterior division of the internal iliac artery can be seen, which gives rise to the inferior
vesical artery. This then divides into the urethral artery and capsular arteries, the latter of which are
preserved because they contribute to the PNVB. The inferior vesical and urethral artery may be clipped or
divided by LigaSure™ as above. Moving down to the pelvic floor, the lateral aspects of the prostate are