Tags

Type your tag names separated by a space and hit enter

Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes.
Eur Urol. 2011 Sep; 60(3):536-47.EU

Abstract

BACKGROUND

Although subtle technical variation affects potency preservation during robot-assisted laparoscopic radical prostatectomy (RARP), most prostatectomy studies focus on achieving the optimal anatomic nerve-sparing dissection plane. However, the impact of active assistant/surgeon neurovascular bundle (NVB) countertraction on sexual function outcomes has not been studied or quantified.

OBJECTIVE

To illustrate technique and compare sexual function outcomes for nerve sparing without (NS-0C) versus with (NS-C) assistant and/or surgeon NVB countertraction.

DESIGN, SETTING, AND PARTICIPANTS

This is a retrospective study of 342 NS-0C versus 268 NS-C RARP procedures performed between August 2008 and February 2011.

SURGICAL PROCEDURE

RARP.

MEASUREMENTS

We used the Expanded Prostate Cancer Index Composite (EPIC) sexual function and potency scores, estimated blood loss (EBL), operative time, and positive surgical margin (PSM).

RESULTS AND LIMITATIONS

In unadjusted analysis, men undergoing NS-0C versus NS-C were older, had worse baseline sexual function, higher biopsy and pathologic Gleason grade, and higher preoperative prostate-specific antigen (PSA) levels (all p ≤ 0.023). However, NS-0C versus NS-C was associated with higher 5-mo sexual function scores (20 vs 10; p < 0.001), and this difference was accentuated for bilateral intrafascial nerve sparing in preoperatively potent men (35.8 vs 16.6; p < 0.001). Similarly, 5-mo potency for preoperatively potent men was better with bilateral intrafascial NS-0C versus NS-C (45.0% vs 28.4%; p = 0.039). However, no difference in sexual function or potency was observed at 12 mo. In adjusted analyses, NS-0C versus NS-C was associated with improved 5-mo sexual function (parameter estimate: 10.90; standard error: 2.16; p < 0.001) and potency (odds ratio: 1.69; 95% confidence interval, 1.01-2.83; p = 0.046). NS-0C versus NS-WC was associated with shorter operative times (p = 0.001) and higher EBL (p = 0.001); however, there were no significant differences in PSM. Limitations include the retrospective, single-surgeon study design and smaller numbers for 12-mo comparison.

CONCLUSIONS

Reliance on countertraction to facilitate dissecting NVB away from the prostate leads to neuropraxia and delayed recovery of sexual function and potency. Subtle technical modification to dissect the prostate away from the NVB without countertraction enables earlier return of sexual function and potency.

Authors+Show Affiliations

Division of Urologic Surgery, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA 02130, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Video-Audio Media

Language

eng

PubMed ID

21620561

Citation

Kowalczyk, Keith J., et al. "Stepwise Approach for Nerve Sparing Without Countertraction During Robot-assisted Radical Prostatectomy: Technique and Outcomes." European Urology, vol. 60, no. 3, 2011, pp. 536-47.
Kowalczyk KJ, Huang AC, Hevelone ND, et al. Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. Eur Urol. 2011;60(3):536-47.
Kowalczyk, K. J., Huang, A. C., Hevelone, N. D., Lipsitz, S. R., Yu, H. Y., Ulmer, W. D., Kaplan, J. R., Patel, S., Nguyen, P. L., & Hu, J. C. (2011). Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. European Urology, 60(3), 536-47. https://doi.org/10.1016/j.eururo.2011.05.001
Kowalczyk KJ, et al. Stepwise Approach for Nerve Sparing Without Countertraction During Robot-assisted Radical Prostatectomy: Technique and Outcomes. Eur Urol. 2011;60(3):536-47. PubMed PMID: 21620561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. AU - Kowalczyk,Keith J, AU - Huang,Andy C, AU - Hevelone,Nathanael D, AU - Lipsitz,Stuart R, AU - Yu,Hua-yin, AU - Ulmer,William D, AU - Kaplan,Joshua R, AU - Patel,Sunil, AU - Nguyen,Paul L, AU - Hu,Jim C, Y1 - 2011/05/17/ PY - 2011/03/25/received PY - 2011/05/02/accepted PY - 2011/5/31/entrez PY - 2011/5/31/pubmed PY - 2011/12/13/medline SP - 536 EP - 47 JF - European urology JO - Eur. Urol. VL - 60 IS - 3 N2 - BACKGROUND: Although subtle technical variation affects potency preservation during robot-assisted laparoscopic radical prostatectomy (RARP), most prostatectomy studies focus on achieving the optimal anatomic nerve-sparing dissection plane. However, the impact of active assistant/surgeon neurovascular bundle (NVB) countertraction on sexual function outcomes has not been studied or quantified. OBJECTIVE: To illustrate technique and compare sexual function outcomes for nerve sparing without (NS-0C) versus with (NS-C) assistant and/or surgeon NVB countertraction. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective study of 342 NS-0C versus 268 NS-C RARP procedures performed between August 2008 and February 2011. SURGICAL PROCEDURE: RARP. MEASUREMENTS: We used the Expanded Prostate Cancer Index Composite (EPIC) sexual function and potency scores, estimated blood loss (EBL), operative time, and positive surgical margin (PSM). RESULTS AND LIMITATIONS: In unadjusted analysis, men undergoing NS-0C versus NS-C were older, had worse baseline sexual function, higher biopsy and pathologic Gleason grade, and higher preoperative prostate-specific antigen (PSA) levels (all p ≤ 0.023). However, NS-0C versus NS-C was associated with higher 5-mo sexual function scores (20 vs 10; p < 0.001), and this difference was accentuated for bilateral intrafascial nerve sparing in preoperatively potent men (35.8 vs 16.6; p < 0.001). Similarly, 5-mo potency for preoperatively potent men was better with bilateral intrafascial NS-0C versus NS-C (45.0% vs 28.4%; p = 0.039). However, no difference in sexual function or potency was observed at 12 mo. In adjusted analyses, NS-0C versus NS-C was associated with improved 5-mo sexual function (parameter estimate: 10.90; standard error: 2.16; p < 0.001) and potency (odds ratio: 1.69; 95% confidence interval, 1.01-2.83; p = 0.046). NS-0C versus NS-WC was associated with shorter operative times (p = 0.001) and higher EBL (p = 0.001); however, there were no significant differences in PSM. Limitations include the retrospective, single-surgeon study design and smaller numbers for 12-mo comparison. CONCLUSIONS: Reliance on countertraction to facilitate dissecting NVB away from the prostate leads to neuropraxia and delayed recovery of sexual function and potency. Subtle technical modification to dissect the prostate away from the NVB without countertraction enables earlier return of sexual function and potency. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/21620561/Stepwise_approach_for_nerve_sparing_without_countertraction_during_robot_assisted_radical_prostatectomy:_technique_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(11)00490-8 DB - PRIME DP - Unbound Medicine ER -