Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes

Tae Young Shin,Yong Seong Lee

doi:10.1038/s41598-020-74513-y

Tae Young Shin, Yong Seong Lee

Open Access

https://doi.org/10.1038/s41598-020-74513-y

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Journal: Scientific Reports	Publication Date: Oct 19, 2020
Citations: 6	License type: open-access

Affiliation: Hallym University Sacred Heart Hospital

Abstract

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25–48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.

Highlights

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP)
Data from the Prostate Cancer Outcomes Study indicate that post-RARP erectile dysfunction significantly affects health-related quality of life in younger men by affecting everyday interactions with partners and perceptions of their own sexuality[10]
After reviewing and employing various erectile function-preserving RARP surgical techniques in our practice, we developed a surgical technique that simultaneously uses athermal dissection and the clipless intrafascial neurovascular bundle-sparing technique

Summary

Introduction

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundlesparing RARP. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Erectile dysfunction after neurovascular bundle-sparing RARP remains a concern, with reported incidence rates ranging from 7.1 to 81.3% at 1-year follow-up[8,9]. After reviewing and employing various erectile function-preserving RARP surgical techniques in our practice, we developed a surgical technique that simultaneously uses athermal dissection and the clipless intrafascial neurovascular bundle-sparing technique. We describe this modified neurovascular bundle-sparing technique and evaluate its postoperative functional and oncologic outcomes

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Conclusion