Neurovascular bundle preservation in robotic-assisted radical prostatectomy: How I do it after 15.000 cases

Abstract

Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center

“…Our referral center accepts privately insured, universally insured Medicare, US Veterans Affairs (VA) populations, and international patients. In our experience, we believe that this full healthcare access is crucial to minimize the difference in outcomes, similar to findings in a universal healthcare ( 8 , 20 ), or single payer systems ( 10 ) due to appropriate prostate cancer screening with PSA, access to imaging exams such as Multiparametric Resonance Image (MRI), and follow-up according to established guidelines.…”

“…All patients underwent RARP by a single surgeon via a six-port configuration, transperitoneal retropubic approach, using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) with our previously described techniques ( 17 – 20 ). We used athermal retrograde release of neurovascular bundles and posterior reconstruction ( 12 ).…”

Robot-Assisted Radical Prostatectomy by the Hugo Robotic-Assisted Surgery (RAS) System and the da Vinci System: A Comparison between the Two Platforms

“…In surgical specimen, positive surgical margins (PSM) were deemed to be an adverse effect [ 12 ]; this was confirmed through peer review by pathologists. Other recordings included bilateral neurovascular bundle (NVB) preservation, blood loss amount, blood transfusion, and surgical conversion rate [ 15 , 16 , 17 ]. Complications were documented and stratified according to the Clavien–Dindo classification [ 18 ].…”

Erectile function, urinary continence and oncologic outcomes of neurovascular bundle sparing robot-assisted radical prostatectomy for high-risk prostate cancer: A systematic review and meta-analysis

“…Moreover, we have no consensus on the classification of NS, nor is there a standard classification of NS at present. Postoperative outcomes may be different due to different types of NS, and the result depends on its percentage ( 45 , 46 ). There is heterogeneity in the NS techniques, which is not addressed in most studies.…”