Nerve Advancement with End-to-End Reconstruction after Partial Neurovascular Bundle Resection:A Feasibility Study

Martínez-Salamanca, Juan Ignacio; Rao, Sandhya; Rajan, Rajesh; González, J. Álvarez-Coca; Mandhani, Anil; Yang, Ximing J.; Tu, Jiangling; Vaughan, E. Darracott; Tewari, Ashutosh

doi:10.1089/end.2007.9946

Cited by 15 publications

(7 citation statements)

References 25 publications

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“…In patients with palpable and more aggressive cancer needing wide local excision, the technique of nerve advancement and end‐to‐end anastomosis has recently been described. A small group of patients appeared to achieve earlier erectile potency after this surgical modification to RARP 26 …”

Section: Potency and Quality Of Lifementioning

confidence: 92%

“…A small group of patients appeared to achieve earlier erectile potency after this surgical modification to RARP. 26 It is important to avoid the use of thermal energy during nerve sparing. Ahlering and colleagues had reported the deleterious effects of cautery on potency and recently updated their results in patients where either monopolar or bipolar cautery had been used for nerve sparing.…”

Section: Potency and Quality Of Lifementioning

confidence: 99%

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Outcomes of robotic assisted radical prostatectomy

Dasgupta

Kirby

2009

Int J of Urology

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Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RARP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic program is a major undertaking for many surgical units. This article reviews the current literature on RARP with regard to oncologic, continence and potency outcomes -the so called 'trifecta'. Preliminary data appears to show an advantage of RARP over open prostatectomy with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most intra-institutional studies demonstrate good postoperative continence and potency with RARP; however this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.

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Section: Potency and Quality Of Lifementioning

confidence: 92%

Section: Potency and Quality Of Lifementioning

confidence: 99%

Outcomes of robotic assisted radical prostatectomy

Dasgupta

Kirby

2009

Int J of Urology

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“…In addition, various grades of NS are possible [32]. It is possible to either resect a small segment of the neurovascular tissue and repair the gap by primary anastomosis [33], or shave off the medial aspect of neurovascular tissue (i.e. incremental NS) to meet the most important goal of surgery, i.e.…”

Section: Discussionmentioning

confidence: 99%

Visual cues as a surrogate for tactile feedback during robotic‐assisted laparoscopic prostatectomy: posterolateral margin rates in 1340 consecutive patients

et al. 2010

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analysed and trends for positive posterolateral SM + (PLSM + ) were correlated with oncological variables before and after RALP. A sample of patient slides were reviewed by a extramural pathologist. Multivariate regression modelling was used to compare the projected rates of PLSM + vs the actual rate, given the effect of a conscious effort to use visual cues. Finally, video recordings of the procedure were systematically reviewed and correlated with anatomical and histopathological images in an integrated session involving the surgeon and the pathology team. RESULTS

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“…However, there is no consensus on the ideal method for NVB reconstruction. While there are a few existing options to choose from, namely sural nerve grafting,[49] use of embryonic stem cells or growth factors to enhance neural regeneration,[50] entubulization model of cavernosal nerve[51] or nerve advancement with end-to-end reconstruction,[52] none of them are employed routinely.…”

Section: Introductionmentioning

confidence: 99%

“…They reported that NAT is technically feasible, oncologically safe and is associated with promising sexual outcomes. [52]…”

Section: Introductionmentioning

confidence: 99%

Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy

et al. 2014

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With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the “trifecta” outcomes.

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Nerve Advancement with End-to-End Reconstruction after Partial Neurovascular Bundle Resection:A Feasibility Study

Abstract: We are encouraged by the initial results of NAT. The procedure may be an alternative for men who require extensive NVB dissection. However, further experience, longer follow-up, and independent trials are necessary.

Cited by 15 publications

References 25 publications

Outcomes of robotic assisted radical prostatectomy

Outcomes of robotic assisted radical prostatectomy

Visual cues as a surrogate for tactile feedback during robotic‐assisted laparoscopic prostatectomy: posterolateral margin rates in 1340 consecutive patients

Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy

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