Abstract
Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles. Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.
Highlights
Prostate cancer is the most commonly diagnosed cancer among men in United States
robot assisted laparoscopic prostatectomy (RALP) offers patients suffering from prostate cancer a minimally invasive approach to radical prostatectomy
In recent meta-analysis studies it has been implicated that RALP has comparable, if not better outcomes than conventional open and laparoscopic procedures
Summary
Prostate cancer is the most commonly diagnosed cancer among men in United States. According to a recent estimate, 192,280 (25%) new patients will be diagnosed with prostate cancer in the year 2009, making it the most commonly diagnosed cancer in men and the second most common cause of death in men [1]. With the advances in Minimally Invasive Surgery (MIS) and its application to the Urology field, Schuessler et al performed the first Laparoscopic Radical Prostatectomy (LRP) in 1992 [3]. It is still extremely difficult to precisely predict the outcomes after radical prostatectomies. The potency rates, depend on many factors such as pre-operative erectile function, patient co-morbidities, type and extent of nerve sparing, patient’s age, frequency of intercourse, use of medications and the experience of the surgeon [8]. This list is not exclusive and there is no foolproof “formula” to ascertain potency recovery even in younger patients
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