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ΣΥΝΈΝΤΈΥΞΗ
Capsular Neurovascular bundle arteries &
veins
Based on this observation in the operating room, I speculated that this neurovascular bundle could be used as the intraoperative landmark to identify the microscopic nerves.
Figure 3
Tεύχος 27 | Iανουάριος - Φεβρουάριος 2024
man. I had never heard of anyone potent after cystoprostatectomy, but ten days postoperatively, when I went to see him in the morning, he said: “Dr. Walsh, I woke up this morning with a normal erection”. So, I knew that we were on the right path.
On April 26, 1982, I performed the first purposeful nerve-sparing radical prostatectomy and that patient lived for another 35 years and died free of cancer, having lived a normal life. There’s a backstory to how I discovered the neurovascular bundles. My Uncle Harry was married to Aunt Anna, my mother’s older sister, who was a nurse. He was a plumber but much rather preferred being out in nature than underneath the sink. When I was about 8 years-old, I had the same passion, so we began to take hikes on Sundays. One summer, we got a Geiger counter and went to Canada to hunt for uranium. Uncle Harry loved to teach me big words. One Sunday, he taught me the auricular-ventricular bundle of His. I have no idea how my uncle, who was a plumber, knew that word and why he taught it to me. After these hikes, we went to his home and Aunt Anna made dinner, giving me the chance to talk to her about medical problems (I always wanted to be a doctor). That evening I looked in her nurse’s dictionary and learned that the auricular- ventricular bundle of His was the neuromuscular bundle between the auricle and the ventricle. So, from the time I was young I knew that autonomic nerves travelled in association with adjacent structures. In 1981 when I saw vessels in the same location as the nerves in that infant cadaver, I immediately I seized on that idea. There’s a wonderful expression that all the young surgeons should know: “You only see what you look for and you only look for what you know!” Sadly, when I was a resident in Urology, Uncle Harry developed metastatic prostate cancer, and died a painful death with Aunt Anna by his side. Today, if you open Stedman’s Medical Dictionary and look up
“bundle”, in the left-hand column of that page you will see the atrioventricular bundle of His, and next to it, in the right-hand column, you will see the “neurovascular bundle of Walsh”. Thank you, Uncle Harry!
T.S.: With your development of the anatomic approach to radical prostatectomy, you have managed to transform radical prostatectomy from a very dangerous and bloody surgery into a safe procedure. Your contributions include recognition of the Santorini plexus and preservation of the urinary sphincters and of the NVBs. In your opinion, which was the most important step in that direction?
P.W.: Obviously, locating the neurovascular bundles and identifying them was number one. But the steps in preservation really depended on discovery of the layers of the lateral pelvic fascia. (4) At that time, every textbook talked about Denonvillier’s’ fascia, but the lateral pelvic fascia was never mentioned. The lateral pelvic fascia is made up of two components: the
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