Tips and Tricks to Improve Neurovascular Bundles Preservation During Robot-Assisted Radical Prostatectomy

Abstract

Objective: We demonstrate various tips and tricks, including latest innovations to improve neurovascular bundles preservation and their outcomes during robot-assisted radical prostatectomy (RARP). Materials and Methods: We have demonstrated our technique of nerve sparing (NS)—athermal, early retrograde release, minimization of tension with identification of landmark artery .We have shown the role of our subjective NS regression model in predicting time to recovery of postoperative erectile function after RARP. We have also shown application of a new innovative technology of near infrared fluorescence (NIRF) using indocyanine green (ICG) in identifying landmark prostatic artery and improving quality of NS. We have also shown the application of an innovative dehydrated human amnion chorion membrane allograft (dHACM) in improving postoperative functional outcomes after RARP. Results: The mean time taken for recovery of postoperative potency was significantly lesser in NS grades 4 and 5 vs grade 0 in subjective NS system. The NIRF with ICG could identify the landmark artery in 17/20 (85%) patients during NS RARP. Fifty-eight patients who were preoperatively potent (Sexual Health Inventory for Men score >19) and continent (no pads) underwent full NS RARP, and dHACM was used. The mean time to continence in dHACM graft group was 1.21 months vs 1.83 months in the nongraft group (p = 0.033). The mean time to potency in dHACM graft group was 1.34 months vs 3.39 months in nongraft group (p = 0.007). Conclusions: The surgeon's experience and volume are the key determinants in NS RARP. The key principles of NS include athermal, minimal traction, and bilateral complete preservation (wherever feasible). The use of these innovations can hasten early return of potency in patients after RARP. No competing financial interests exist. Runtime of video: 6 mins 55 secs