Application of modified Veil nerve-sparing technique in laparoscopic radical prostatectomy

Abstract

Objective To explore the application and early efficacy of modified Veil nerve-sparing technique during laparoscopic radical prostatectomy (LRP). Methods Fifty-seven modified Veil nerve-sparing during LRP procedures were performed in patients with clinically localized prostate cancer between 2012 and 2016 by the same surgeon. Preoperative PSA level was 10.9 μg/ml, and Gleason score was 6.06 (5-8). TNM clinical stage showed cT1 in 39 cases and cT2 in 18 cases. All patients underwent transrectal ultrasonography before operation. Prostate volume was 40.2 (26-99) ml. ECT bone scan excluded bone metastasis. MRI or CT examination showed no obvious prostate invasion and lymph node metastasis. The key technology was anatomical separation of detrusor apron, dorsal vascular complex (DVC) and the level between the prostate capsule, and a complete reservation was accomplished. Measurements: the rates and location of positive surgical margins (PSM) and tumor biochemical recurrence rate as well as functional outcomes were presented. Questionnaires were used to assess urine function and IIEF-5 score was used to estimate sexual function. Results Fifty-seven cases were followed up, and the average follow-up of 27.3 (6-65) months. Five cases showed biochemical recurrence after 23 months. Five patients had a PSM (2 patients in apical margins, 1 patient in left side, 1 patient in right side and 1 patient in the bottom). At catheter removal, 49 of 57 patients (86%) were dry (0 pads), and 8 of 57 patients (14%) needed one security pad. After 3 months and 6 months, 42% (24 of 57 patients) and 60% (34 of 57 patients) presented an International Index of Erectile Function score >15 (with or without phospho-diesterasetype-5inhibitors). Conclusions The modified Veil nerve-sparing technique during LRP can retain the fascia around the prostate more completely and restore postoperative urine and erectile function early.For selective cases, it will not increase the positive rate of surgical margins and biochemical recurrence rate. Key words: Laparoscopy; Prostatic neoplasms; Urinary incontinence; Sexual function