Application of Denonvilliers' Fascia Arch as an Anatomical Landmark in Laparoscopic Radical Prostatectomy: A Retrospective Cohort Study.

Abstract

This study aims to evaluate the clinical application of Denonvilliers' fascia arch (DFA) as a novel anatomical landmark in laparoscopic radical prostatectomy (LRP), comparing with the conventional extraperitoneal LRP approach. This retrospective cohort study analyzed 304 patients who underwent LRP between January 2019 and January 2024. Patients were divided into two groups: the experimental group (n = 152), who underwent extraperitoneal LRP using DFA as a landmark, and the control group (n = 152), who underwent conventional LRP. Perioperative outcomes, including surgical time, blood loss, complications, and functional recovery (urinary continence and erectile function), were evaluated. Logistic regression analysis assessed the risk factors for postoperative urinary incontinence and erectile dysfunction. The experimental group showed significantly improved outcomes. The median surgical time was 134 minutes, compared with 171 minutes in the control group (P < 0.001). Intraoperative blood loss was lower in the experimental group (58 mL vs. 103 mL, P < 0.001). The incidence of rectal injury was lower (1 vs. 9 cases, P = 0.010), and the Clavien-Dindo grade ≥ II complication rate was significantly reduced (3.3% vs. 10.4%, P = 0.013). The experimental group also showed better recovery in urinary continence (30.9% vs. 17.8%, P = 0.008) and erectile function (median IIEF score of 8 vs. 6, P < 0.001). The use of DFA as a landmark in LRP improves surgical efficiency, reduces complications, and enhances functional recovery compared to the conventional approach. DFA provides an effective method for precise DF identification, offering substantial clinical value in LRP.