Athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy

Abstract

While cancer control is the primary objective of radical prostatectomy, maintenance of sexual function is a priority for the majority of men presenting with prostate cancer. Preservation of the neurovascular bundles is the challenging and critical step of radical prostatectomy with regards to maintenance of potency. The objective of this study is to describe the surgical steps of our hybrid technique: athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy. This technique involves releasing the neurovascular bundle in a retrograde direction from the apex toward the base of the prostate, during an antegrade prostatectomy. It is a hybrid of the traditional open and the laparoscopic approaches to nerve sparing. With this approach we are able to clearly delineate the path of the bundle and avoid inadvertently injuring it when controlling the prostatic pedicle. Our hybrid nerve-sparing technique combines aspects of the traditional open anatomical approach with those of the laparoscopic antegrade approach. The benefits of robotic technology allow a retrograde neurovascular bundle dissection to be performed during an antegrade radical prostatectomy.

Clinical effect of a positive surgical margin without extraprostatic extension after robot-assisted radical prostatectomy

“…Most procedures were performed using the 6-port technique. Most of the nerve-sparing procedures were performed using the interfascial technique previously reported by Coughin et al [9]. The prostatectomy specimens were fixed in 10% formalin and completely inked first to enable accurate assessment of the surgical margin status.…”

Prediction of biochemical recurrence after robot‐assisted radical prostatectomy: Analysis of 784 Japanese patients

“…Excluding these patients, we retrospectively analyzed 784 patients who underwent RARP for localized prostate cancer. RARP was carried out using the six-port technique in most cases, and most nervesparing procedures were carried out using the interfascial technique, as reported previously by Coughlin et al 16 Basically, dissection of the obturator lymph nodes was carried out in these patients. However, some patients with a very low risk of lymph node metastasis did not undergo a lymph node dissection.…”

Predictors for positive surgical margins after robot‐assisted radical prostatectomy: A single surgeon's series in Japan

“…However, on patient request, a nerve‐sparing procedure could be carried out in patients with biopsy Gleason score of 8 or more, although preferably in those with biopsy positive cores in only one lobe and serum PSA levels of less than 20 ng/mL. The interfascial nerve‐sparing procedure was carried out athermally with an early retrograde release of the neurovascular bundles before ligation of the prostatic pedicles, as reported previously by Coughin et al …”