Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA
Cancer control and the preservation of neurovascular tissue: how to meet competing goals during robotic radical prostatectomy
Article first published online: 5 FEB 2008
© 2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL
Volume 101, Issue 8, pages 1013–1018, April 2008
How to Cite
Tewari, A., Rao, S., Martinez-Salamanca, J. I., Leung, R., Ramanathan, R., Mandhani, A., Vaughan, E. D., Menon, M., Horninger, W., Tu, J. and Bartsch, G. (2008), Cancer control and the preservation of neurovascular tissue: how to meet competing goals during robotic radical prostatectomy. BJU International, 101: 1013–1018. doi: 10.1111/j.1464-410X.2008.07456.x
- Issue published online: 19 MAR 2008
- Article first published online: 5 FEB 2008
- Accepted for publication 27 September 2007
- neuroanatomical map;
- prostate cancer;
- robotic prostatectomy
Study Type – Therapy (case series) Level of Evidence 4
To present early functional and oncological data for the athermal trizonal nerve-sparing technique of robotic radical prostatectomy (RP), that addresses the concerns about deviations from the principles of open RP and revisits the anatomical foundations of this surgery from the robotic perspective.
PATIENTS AND METHODS
The study involved close collaboration between the Cornell Institute of Robotic Surgery in New York, USA, and the Institute of Urology at the University of Innsbruck in Austria. The cadaveric studies and standardization of the athermal technique were conducted at Innsbruck, and the technique was used in 215 patients in New York.
The athermal technique addresses concerns about the use of thermal energy and bulldog clamps during nerve sparing, and emphasizes the importance of the trizonal neural architecture. We analysed the surgical outcomes of 215 consecutive patients from January 2005. The operative duration was 120–240 min and the mean blood loss was 150 mL. In patients potent before RP the potency rate at 1 year after bilateral nerve-sparing was 87%. The overall surgical margin rate was 6.5% and positive margin rates for organ-confined cancer were 4.7%.
We describe the athermal technique of robotic RP and introduce the concept of trizonal nerve preservation. The immediate oncological and sexual outcomes were encouraging.