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Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation.
Urology. 2005 Aug; 66(2):419-23.U

Abstract

INTRODUCTION

We present our technique for clipless antegrade neurovascular bundle preservation during robotic laparoscopic radical prostatectomy, along with short-term follow-up of our patients' sexual function.

TECHNICAL CONSIDERATIONS

Using the da Vinci three-arm robotic system, we performed robotic laparoscopic radical prostatectomy using a transperitoneal approach in an antegrade fashion. After division of the bladder neck, the posterior plane of the prostate was developed distally toward the apex of the prostate in the midline. This plane was then developed completely, releasing the vascular pedicles and neurovascular bundles in a medial to lateral direction, with occasional use of bipolar cautery and without the use of clips or monopolar cautery. Patients with a minimal follow-up of 3 months who did not require open conversion were included in this study. A total of 56 patients met these inclusion criteria between February 2003 and May 2004, with a mean follow-up of 6 months. Patients were given the validated Rand Medical Outcomes Study 36-Item Health Survey, version 2, with the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. The overall score for both unilateral and bilateral nerve-sparing groups was 35.0, 39.7, 49.4, and 49.6 at 1, 3, 6, and 12 months postoperatively, respectively. These coincided with a return to baseline potency rate of 47%, 54%, 66%, and 69% at 1, 3, 6, and 12 months, respectively.

CONCLUSIONS

Antegrade dissection of the neurovascular bundle, avoiding the use of clips or monopolar cautery during robotic laparoscopic radical prostatectomy, may result in early return of sexual function and overall outcome similar to that after radical retropubic prostatectomy.

Authors+Show Affiliations

Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16040100

Citation

Chien, Gary W., et al. "Modified Clipless Antegrade Nerve Preservation in Robotic-assisted Laparoscopic Radical Prostatectomy With Validated Sexual Function Evaluation." Urology, vol. 66, no. 2, 2005, pp. 419-23.
Chien GW, Mikhail AA, Orvieto MA, et al. Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology. 2005;66(2):419-23.
Chien, G. W., Mikhail, A. A., Orvieto, M. A., Zagaja, G. P., Sokoloff, M. H., Brendler, C. B., & Shalhav, A. L. (2005). Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology, 66(2), 419-23.
Chien GW, et al. Modified Clipless Antegrade Nerve Preservation in Robotic-assisted Laparoscopic Radical Prostatectomy With Validated Sexual Function Evaluation. Urology. 2005;66(2):419-23. PubMed PMID: 16040100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. AU - Chien,Gary W, AU - Mikhail,Albert A, AU - Orvieto,Marcelo A, AU - Zagaja,Gregory P, AU - Sokoloff,Mitchell H, AU - Brendler,Charles B, AU - Shalhav,Arieh L, PY - 2004/11/03/received PY - 2005/02/25/revised PY - 2005/03/02/accepted PY - 2005/7/26/pubmed PY - 2005/12/13/medline PY - 2005/7/26/entrez SP - 419 EP - 23 JF - Urology JO - Urology VL - 66 IS - 2 N2 - INTRODUCTION: We present our technique for clipless antegrade neurovascular bundle preservation during robotic laparoscopic radical prostatectomy, along with short-term follow-up of our patients' sexual function. TECHNICAL CONSIDERATIONS: Using the da Vinci three-arm robotic system, we performed robotic laparoscopic radical prostatectomy using a transperitoneal approach in an antegrade fashion. After division of the bladder neck, the posterior plane of the prostate was developed distally toward the apex of the prostate in the midline. This plane was then developed completely, releasing the vascular pedicles and neurovascular bundles in a medial to lateral direction, with occasional use of bipolar cautery and without the use of clips or monopolar cautery. Patients with a minimal follow-up of 3 months who did not require open conversion were included in this study. A total of 56 patients met these inclusion criteria between February 2003 and May 2004, with a mean follow-up of 6 months. Patients were given the validated Rand Medical Outcomes Study 36-Item Health Survey, version 2, with the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. The overall score for both unilateral and bilateral nerve-sparing groups was 35.0, 39.7, 49.4, and 49.6 at 1, 3, 6, and 12 months postoperatively, respectively. These coincided with a return to baseline potency rate of 47%, 54%, 66%, and 69% at 1, 3, 6, and 12 months, respectively. CONCLUSIONS: Antegrade dissection of the neurovascular bundle, avoiding the use of clips or monopolar cautery during robotic laparoscopic radical prostatectomy, may result in early return of sexual function and overall outcome similar to that after radical retropubic prostatectomy. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/16040100/Modified_clipless_antegrade_nerve_preservation_in_robotic_assisted_laparoscopic_radical_prostatectomy_with_validated_sexual_function_evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(05)00325-0 DB - PRIME DP - Unbound Medicine ER -