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Page 10 of 18 Thinagaran et al. Mini-invasive Surg 2021;5:46 https://dx.doi.org/10.20517/2574-1225.2021.53

Figure 13. Dissection of the prostatic apex before division of the dorsal vein complex.

Figure 14. Transection of the anterior urethral wall.

the ANPs. Further inferiorly the PNVB may be seen and is also dissected away from the prostate laterally,
with as little tension and cautery as possible. Once this plane is found, dissection continues towards the
prostatic apex, with the lateral prostatic fascia and PNVB laterally, down to the pelvic floor, until the
prostate-urethral junction. At the apex, the PNVBs run alongside the urethra at 10 and 2 o’clock, and
careful suturing of the dorsal vein should avoid these areas, as well as making sure to minimize dissection
around the surrounding structures and muscle tissue to prevent injuring branches of the pudendal nerves
and accessory vessels . A continuing awareness for nerve preservation is important during the ELND,
[17]
where sparing lymph nodes at the lateral pedicle between the ureters and bladder near the vesico-ureteric
junction prevents injury to the hypogastric nerves carrying sympathetic fibres to the pelvic plexus
[17]
(described above) .

Technical variations on NS
Two variations on the common NS approach have also been described including capsule sparing
[15]
cystectomy and SV sparing cysto-prostatectomy . The capsule sparing technique involves a pre cystectomy