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C145 First experience with intraoperative stimulation of pelvic floor somatic nerves during robotic assisted radical prostatectomy
C145
First experience with intraoperative stimulation of pelvic floor somatic nerves during robotic assisted radical prostatectomy Eur Urol Suppl 2013;12;e1253
Belej K.1, Kohler O.2, Kaplan O.1, Kocarek J.1, Chmelik F.1 1Military
University Hospital Prague, Dept. of Urology, Prague, Czech Republic, 2Na Homolce Hospital, Dept. of Surgery,
Prague, Czech Republic INTRODUCTION & OBJECTIVES: Despite considerable technical advances in radical surgery of prostate cancer it is not possible to restore urinary continence in all patients. Abstract summarizes first experience with intraoperative pelvic floor motoric nerves mapping. MATERIAL & METHODS: Intraoperative stimulation was performed in six patients during extraperitoneoscopic robotic assisted radical prostatectomy. Surgeries were performed with four arm robotic system (DaVinci® Standard, Intuitive Surgical Inc., California, USA) with one assistant port and stimulation device (ProPep Nerve Monitoring System™, ProPep Surgical Inc., Texas, USA) which was connected to bipolar coagulation forceps. RESULTS: Patients with localized or low volume locally advanced prostate cancer without any other selection according to Gleason score, prostatic specific antigen or prostate volume were indicated for surgery. Anesthesiologist provided procedure without muscle relaxation. Bipolar coagulation forceps were connected to coagulation unit through stimulation device after common preparation. Two working modes (stimulation/coagulation) could be switched at robotic console. Two needle electrodes were introduced to retropubic space just above pubic symphysis and were sticked into ventral part of pelvic floor muscles. Neutral thin needle electrode was applied to abdominal subcutaneous tissue. Stimulation with somatic nerves mapping was performed after separation prostate from levator ani muscle, during deliberation of lateral sides of prostate and after removing of specimen from prostatic bed. Procedure passed without any complications in all cases, overtime for mapping didn´t exceed five minutes in any patient. Even in a small number of patients we confirmed variable course of nerves and their sparing at the end of ablation phase. CONCLUSIONS: Intraoperative somatic nerves stimulation is another feasible opportunity for improving functional results and urinary continence after radical prostatectomy. Further studies with more patients are needed to define proper role of this technique.
First experience with intraoperative stimulation of pelvic floor somatic nerves during robotic assisted radical prostatectomy Eur Urol Suppl 2013;12;e1253
Belej K.1, Kohler O.2, Kaplan O.1, Kocarek J.1, Chmelik F.1 1Military
University Hospital Prague, Dept. of Urology, Prague, Czech Republic, 2Na Homolce Hospital, Dept. of Surgery,
Prague, Czech Republic INTRODUCTION & OBJECTIVES: Despite considerable technical advances in radical surgery of prostate cancer it is not possible to restore urinary continence in all patients. Abstract summarizes first experience with intraoperative pelvic floor motoric nerves mapping. MATERIAL & METHODS: Intraoperative stimulation was performed in six patients during extraperitoneoscopic robotic assisted radical prostatectomy. Surgeries were performed with four arm robotic system (DaVinci® Standard, Intuitive Surgical Inc., California, USA) with one assistant port and stimulation device (ProPep Nerve Monitoring System™, ProPep Surgical Inc., Texas, USA) which was connected to bipolar coagulation forceps. RESULTS: Patients with localized or low volume locally advanced prostate cancer without any other selection according to Gleason score, prostatic specific antigen or prostate volume were indicated for surgery. Anesthesiologist provided procedure without muscle relaxation. Bipolar coagulation forceps were connected to coagulation unit through stimulation device after common preparation. Two working modes (stimulation/coagulation) could be switched at robotic console. Two needle electrodes were introduced to retropubic space just above pubic symphysis and were sticked into ventral part of pelvic floor muscles. Neutral thin needle electrode was applied to abdominal subcutaneous tissue. Stimulation with somatic nerves mapping was performed after separation prostate from levator ani muscle, during deliberation of lateral sides of prostate and after removing of specimen from prostatic bed. Procedure passed without any complications in all cases, overtime for mapping didn´t exceed five minutes in any patient. Even in a small number of patients we confirmed variable course of nerves and their sparing at the end of ablation phase. CONCLUSIONS: Intraoperative somatic nerves stimulation is another feasible opportunity for improving functional results and urinary continence after radical prostatectomy. Further studies with more patients are needed to define proper role of this technique.