How to cite: Tewari AK. “Technical Advances for Robotic Laparoscopic Prostatectomy.” October 23, 2025. Accessed Apr 2026. https://grandroundsinurology.com/technical-advances-for-robotic-laparoscopic-prostatectomy/
Summary
Ashutosh K. Tewari, MD, MBBS, MCh, FRCS, Chairman and Director of the Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, presents a comprehensive surgical atlas of the prostate, tracing the evolution of nerve-sparing radical prostatectomy from foundational anatomy to advanced robotic technique.
The central focus is the neuroanatomy of the pelvis and its implications for functional outcomes following prostate cancer surgery. Dr. Tewari challenges the traditional concept of discrete left and right neurovascular bundles, instead describing a complex neurovascular hammock composed of interconnecting autonomic nerves, ganglia, vessels, and fascial layers that surround and support the prostate. This hammock is intimately associated with continence and sexual function, concealed within millimeters of tissue that must be preserved during cancer excision.
Detailed anatomical insights from fresh cadaver dissections, three-dimensional modeling, and real-time imaging clarify the spatial relationships between the prostate capsule, periprostatic fascia, Denonvilliers’ fascia, levator muscles, and neurovascular structures. The biologic interaction between prostate cancer and nerves is explored, including perineural invasion and extracapsular extension, underscoring the need for individualized surgical planning.
Dr. Tewari demonstrates refined surgical techniques, including bladder neck preservation, hood preservation, graded nerve-sparing strategies, and meticulous traction control. A novel hydrodissection technique is shown, using saline to separate fascial planes intraoperatively, rendering nerves visible and reducing mechanical and thermal injury.
Dr. Tewari shares emerging applications of artificial intelligence in prostate surgery, including real-time nerve identification, intraoperative performance analysis, and predictive modeling of functional recovery. Together, these advances aim to standardize precision surgery while preserving oncologic control and quality of life.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Ashutosh K. Tewari, MD, MBBS, MCh, FRCS, is Chairman and Director of the Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai in New York, New York. Dr. Tewari is also the Director of the Center of Excellence for Prostate Cancer at the Mount Sinai Tisch Cancer Center. His focus is in prostate cancer, including targeted biopsies, cytoscopies, robotic prostatectomies, and the management of active surveillance prostate cancer patients.
Dr. Tewari earned his MBBS at GSVM Medical College in Kanpur, India. He then completed a Urology residency at Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow, India, followed by fellowships in Urologic Oncology at the University of California, San Francisco, and the University of Florida in Gainesville. He then completed a second Urology residency at Henry Ford Hospital in Detroit, Michigan.
In 2012, Dr. Tewari was awarded the American Urological Association’s Gold Cystoscope Award, and he has received three major National Institutes of Health Federal Research Awards. He is a member of the American Urological Association, the Society of Minimally Invasive Surgery, the Society of Robotic Surgery, and the Society of Urologic Oncology. Additionally, he has been listed consecutively inNew York Magazine’sTop Doctors since 2006. Dr. Tewari has authored over 250 peer-reviewed articles, book chapters, and textbooks on prostate cancer and robotic surgery, including several articles inCell,Nature, andThe Proceedings of the National Academy of Sciences.
