852 RESULTS OF USING A NEW TECHNOLOGY TO IMPROVE THE IDENTIFICATION AND PRESERVATION OF NERVE TISSUE DURING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013852 RESULTS OF USING A NEW TECHNOLOGY TO IMPROVE THE IDENTIFICATION AND PRESERVATION OF NERVE TISSUE DURING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Ronald Kuhn and Ronald Kuhn Ronald KuhnRonald Kuhn North Little Rock, AR More articles by this author and Ronald KuhnRonald Kuhn North Little Rock, AR More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.420AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Efforts to improve continence after robotic assisted laparoscopic radical prostatectomy (RALRP) have focused on preserving periurethral and bladder neck tissue along with posterior reconstruction and anterior suspension. Many patients still have varying degrees of urinary incontinence. Literature has shown that nerves innervating the levator ani (LA) contribute to continence and anatomic landmarks are not accurate in determining their location. Inadvertent damage to these nerves may contribute to post RALRP incontinence. Intra-operative identification of nerve tissue using a stimulated EMG produces a waveform known as a compound motor action potential (CMAP) and is standard of care in brain, spine and facial surgery. The Author used a new technology that elicits and records CMAP's during RALRP and evaluated the ability to identify and preserve the nerves innervating the LA. METHODS 20 consecutive patients underwent RALRP using a posterior dissection without bias for stage, age, BMI, or commorbidites. After opening the endopelvic fascia and dividing the bladder neck, two 0.2mm diameter electrodes were passed through the anterior abdominal and placed into the LA bilaterally. A stimulatory signal was delivered through a daVinci bipolar instrument and CMAP's were recorded and used to identify the nerve to the LA during the procedure. 8 weeks post-op patients completed an EPIC score to measure urinary incontinence. RESULTS The nerves innervating the LA were identified in 100% of the cases as demonstrated by eliciting a CMAP that corresponded to known CMAP's from other motor nerves. The use of this technology added less than 2 minutes to procedure times. A correlation was seen between increasing CMAP amplitude and increasing proximity to the nerves. Additionally, EPIC scores at 8 weeks post RALRP revealed that improved post-operative continence was associated with a shorter intra-op CMAP latency. CONCLUSIONS Real-time intra operative monitoring of the otherwise invisible nerves that innervate the LA during RALRP is reproducible and efficient using this new technology. The information gained by using this technology correlates with proximity to the nerve and postoperative continence. Therefore, the use of this technology and the intra operative information it provides, accompanied by careful anatomic dissection demonstrates great promise in improving continence after RALRP. Further study is warranted in exploring how using this technology may improve postoperative continence following RALRP. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e350 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronald Kuhn North Little Rock, AR More articles by this author Ronald Kuhn North Little Rock, AR More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...