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V17 Early NVBs release in RARP: The technique
V17
Early NVBs release in RARP: The technique Eur Urol Suppl 2016;15(3);eV17
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Ferrari M., Fabbri F., Zanoni M., Ghezzi M., Sangalli M., Sozzi F., Lolli C., Dell'Acqua V., Rigatti P., Cestari A. Istituto Auxologico Italiano, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: We describe a new Nerve-Sparing (NS) technique during Robotic Radical Prostatectomy (RARP) with an early neurovascular bundle release in order to improve the potency rate. Surgical technique and preliminary data regarding its effectiveness in improving Erectile Function (EF) recovery are presented. MATERIAL & METHODS: Between February 2014 and October 2014 a cohort of 70 patients affected by localized prostate cancer candidate to RARP with bilateral NS approach at single high-volume centre were enrolled and submitted to new technique (early NVBs release group). The key-points of our technique were the following: 1) Incision of the peritoneum at the level of the Douglas pouch and initial posterior approach with isolation and dissection of vas deferens and seminal vesicles along the inner layer of Denonvilliers fascia; 2) using a 30° optic upward oriented, anterior and lateral progression toward the prostate pedicles is performed by dissecting the posterolateral aspect of the NVBs from the prostate; 3) once the bladder is mobilized and the endopelvic fascia incised to expose the prostate, incision of anterior prostatic fascia, lateral dissection of NVBs and achievement of posterior space first isolated are performed; 4) completion of prostatectomy with dissection of prostate vascular pedicles by use of Hem-o-lok clips; 5) entire procedure was energy-free, without the use of coagulation and taking care of performing a gentle dissection. EF recovery was assessed at 6 and 12 months post-operatively through a structured interview including the score of International Index of Erectile Function questionnaire – Erectile Function Domain (IIEF-EF ). EF recovery was compared retrospectively to previous series of consecutive NS-RARP performed with the traditional NS-approach (N = 70 patients). EF was defined as IIEF-EF score ≥ 19 with or without the use of PDE5Is. RESULTS: Complete data collection was available for 140/140 (100%) patients. Mean±SD age was 66±9.0 years. At 6 months of follow up EF recovery was 87% in the early NVBs release group compared to 45% in the standard group; at 12 month up 96% and 65% respectively. CONCLUSIONS: Although these data have to be confirmed in a larger sample of patients, our initial experience indicates that our approach of early NVBs release is technically feasible with promising data on EF recovery in patients undergoing RARP.
Early NVBs release in RARP: The technique Eur Urol Suppl 2016;15(3);eV17
Print! Print!
Ferrari M., Fabbri F., Zanoni M., Ghezzi M., Sangalli M., Sozzi F., Lolli C., Dell'Acqua V., Rigatti P., Cestari A. Istituto Auxologico Italiano, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: We describe a new Nerve-Sparing (NS) technique during Robotic Radical Prostatectomy (RARP) with an early neurovascular bundle release in order to improve the potency rate. Surgical technique and preliminary data regarding its effectiveness in improving Erectile Function (EF) recovery are presented. MATERIAL & METHODS: Between February 2014 and October 2014 a cohort of 70 patients affected by localized prostate cancer candidate to RARP with bilateral NS approach at single high-volume centre were enrolled and submitted to new technique (early NVBs release group). The key-points of our technique were the following: 1) Incision of the peritoneum at the level of the Douglas pouch and initial posterior approach with isolation and dissection of vas deferens and seminal vesicles along the inner layer of Denonvilliers fascia; 2) using a 30° optic upward oriented, anterior and lateral progression toward the prostate pedicles is performed by dissecting the posterolateral aspect of the NVBs from the prostate; 3) once the bladder is mobilized and the endopelvic fascia incised to expose the prostate, incision of anterior prostatic fascia, lateral dissection of NVBs and achievement of posterior space first isolated are performed; 4) completion of prostatectomy with dissection of prostate vascular pedicles by use of Hem-o-lok clips; 5) entire procedure was energy-free, without the use of coagulation and taking care of performing a gentle dissection. EF recovery was assessed at 6 and 12 months post-operatively through a structured interview including the score of International Index of Erectile Function questionnaire – Erectile Function Domain (IIEF-EF ). EF recovery was compared retrospectively to previous series of consecutive NS-RARP performed with the traditional NS-approach (N = 70 patients). EF was defined as IIEF-EF score ≥ 19 with or without the use of PDE5Is. RESULTS: Complete data collection was available for 140/140 (100%) patients. Mean±SD age was 66±9.0 years. At 6 months of follow up EF recovery was 87% in the early NVBs release group compared to 45% in the standard group; at 12 month up 96% and 65% respectively. CONCLUSIONS: Although these data have to be confirmed in a larger sample of patients, our initial experience indicates that our approach of early NVBs release is technically feasible with promising data on EF recovery in patients undergoing RARP.