Incremental nerve sparing A. Mottrie

The anterior release divides fascial layers down to the surface of the prostate (depending on the nerve sparing grade)

The pedicles are divided using hem-o-locks

5 mm clips can be used to control small vessels close to the neurovascular bundles

The dissection is then continued on the posterior surface of the prostate

A blunt dissection should ideally be performed. Cutting might be necessary to define the correct plan and to reduce the risk of positive margins

In case of locally advanced or bulky disease an extrafascial dissection represents a safe approach from an oncologic standpoint