Saline-Assisted Fascial Engorgement Nerve Preservation Guided by Microultrasound During Robot-Assisted Radical Prostatectomy

Bermeo, Adriana Marcela Pedraza; Wagaskar, Vinayak; Schlussel, Kacie; Berryhill, Roy; Haas, Ian; Pandav, Krunal; Tewari, Ashutosh

doi:10.1089/vid.2022.0025

Cited by 1 publication

(3 citation statements)

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“…1): In the TR approach, a high‐resolution ultrasound with a 29 MHz transducer (ExactVu micro‐ultrasound, Exact Imaging, Markham, Canada) was used to assess the prostate. Moving from the apex toward the base, 20 mL normal saline solution was injected with a 22‐G × 178‐mm (7‐inch) spinal needle after establishing the plane between Denonvilliers’ fascia and the prostatic capsule [16]. In the TP SAFE under direct vision and using the right assistant port, a 23‐G ×19‐mm (¾‐inch) butterfly needle was introduced to inject 20 mL saline solution in between the fascial layers.…”

Section: Methodsmentioning

confidence: 99%

“…Moving from the apex toward the base, 20 mL normal saline solution was injected with a 22-G 9 178-mm (7-inch) spinal needle after establishing the plane between Denonvilliers' fascia and the prostatic capsule [16]. 2.…”

Section: Ralp + Safe Techniquementioning

confidence: 99%

“…Using transrectal (TR) micro-ultrasound (MUS), we earlier proposed the idea of intraoperative HD for fascial separation, which was inspired by the principle of minimising trauma in the periprostatic neural hammock. The term 'saline-assisted fascial exposure' (SAFE) was used to describe this method [16]. The saline solution is utilised to delicately separate planes and expose the multilayered periprostatic fascia, thereby isolating the neural hammock and facilitating nerve visualisation.…”

Section: Introductionmentioning

confidence: 99%

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Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

Pedraza,

Gupta,

Joshi

et al. 2023

BJU International

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ObjectiveTo provide a summary of our initial experience and assess the impact of the Saline‐Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot‐Assisted Laparoscopic Radical Prostatectomy (RALP).Patients and MethodsFrom January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro‐ultrasound or transperitoneal. Its principle entails a low‐pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day.ResultsAt follow‐up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log‐rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.ConclusionsThe use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.

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