V480 FLEXIBLE CO 2 LASER ASSISTED NEUROVASCULAR BUNDLE DISSECTION FOR ROBOTIC PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Oncology1 Apr 2010V480 FLEXIBLE CO2 LASER ASSISTED NEUROVASCULAR BUNDLE DISSECTION FOR ROBOTIC PROSTATECTOMY Philippa Cheetham, Matthew Truesdale, and Ketan Badani Philippa CheethamPhilippa Cheetham More articles by this author , Matthew TruesdaleMatthew Truesdale More articles by this author , and Ketan BadaniKetan Badani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Carbon dioxide (CO2) lasers have been cited to deliver energy with minimal thermal spread to tissues during dissection. The CO2 laser is thus widely used in head and neck oncology surgery and neurosurgery, resulting in predictable penetration depth and minimal collateral damage. Until recently, use of the CO2 laser as a surgical tool has been limited by the necessity for delivery through a rigid, rather than a fiber-based flexible delivery system. Excess thermal spread during neurovascular bundle (NVB)dissection can affect potency in men following radical prostatectomy. We report on a novel delivery of CO2 laser energy through a flexible fiber to enhance the accuracy of dissection of the NVB during robotic assisted laparoscopic prostatectomy (RALP). METHODS A feasibility study of the OmniGuide® BeamPath™ URO-LG CO2 laser fiber for neurovascular bundle dissection was performed on 8 men with clinical stage T1c, Gleason 6 or 7 prostate cancer during RALP. Upon identification of the NVB, a large needle driver was used to manipulate the fiber. Bilateral lateral fascial nerve sparing was performed in antegrade fashion. RESULTS We evaluated the performance, safety and efficacy of the fiber, which was successfully inserted through the assistant's port (12 mm). The size of the device allowed adequate space for simultaneous insertion of standard 5 mm laparoscopic tools. The fiber was easily manipulated by robotic instruments.Once the pedicles were clipped and dissected, the laser fiber was effective in establishing the plane of dissection between the prostatic capsule and the neurovascular bundle. Visual examination indicated that the thermal footprint of the laser was small, with minimal thermal spread during the nerve sparing portion of the procedure. This resulted in meticulous dissection of the NVB and fascial layer identification.The use of the laser fiber was safe with precise soft tissue cutting, stemming from its ready absorption in water. Whilst the laser did provide extremely accurate dissection, it was unable to serve as an adequate means of coagulation in larger vessels. CONCLUSIONS The flexible CO2 laser fiber was easily manipulated and identification of fascial layers during nerve sparing was facilitated with the fiber. Long-term follow-up is necessary to determine the efficacy of this technology versus conventional techniques on the NVB. Larger studies are currently in progress to determine if use of the flexible CO2 laser fiber results in improvements in functional outcomes with regards to return of sexual potency following robotic prostatectomy. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e189 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippa Cheetham More articles by this author Matthew Truesdale More articles by this author Ketan Badani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...