Cavernosal Nerve Preservation During Robot-assisted Radical Prostatectomy Is a Graded Rather Than an All-or-none Phenomenon: Objective Demonstration by Assessment of Residual Nerve Tissue on Surgical Specimens

Schatloff, Oscar; Chauhan, Sanket; Kameh, Darian; Valéro, R.; Ko, Young Hwii; Sivaraman, Ananthakrishnan; Coelho, Rafael F.; Marquinez, Jeff; Palmer, Kenneth J.; Patel, Vipul

doi:10.1016/j.urology.2011.11.029

Cited by 20 publications

(17 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to our prior publication, we proposed that NS can be graded into five levels, depending on the amount of tissue the surgeon decides to leave on each side . Various papers have shown that NS classification according to the surgeon's intraoperative perception correlates with the residual nerve tissue found on specimens .…”

Section: Introductionmentioning

confidence: 99%

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…The neuro‐anatomy of the structures surrounding the prostate has been more clearly discerned and a better understanding of the multi‐layered structure of the LPF has been achieved. Additionally, thanks to the magnification allowed by the robotic approach, different grades of NVB preservation during RARP are now possible and previous studies have shown that the surgeon's intraoperative perception actually correlates with the neurovascular tissue left on the specimen .…”

Section: Discussionmentioning

confidence: 99%

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

et al. 2019

View full text Add to dashboard Cite

A.M. and S.C. contributed equally to this work ObjectivesTo update the algorithm for performing incremental nerve sparing (NS) using our multiparametric magnetic resonance imaging (mpMRI)-based nomogram. Patients and methodsWe applied the coefficients of the nomogram to the observations extracted from our population of patients who underwent robot-assisted radical prostatectomy between February 2014 and October 2015 and who received preoperative mpMRI. The information considered were PSA level, highest side-specific biopsy Gleason grade group, highest ipsilateral percentage core involvement with the highest Gleason grade group, and extracapsular extension (ECE) on mpMRI. The nomogram-derived probability [P (%)], after internal validation, was used as the independent variable on a classification tree to identify the most significant thresholds for ECE prediction. Incremental NS was performed as follows: Grade 1 NS: intrafascial dissection between the peri-prostatic veins and the pseudocapsule of the prostate; Grade 2 NS: inter-fascial dissection along the perivenous plane; Grade 3 NS: inter-fascial dissection through the outer compartment of the lateral prostatic fascia; Grade 4 NS: extrafascial dissection. ResultsData from 561 patients were considered, and 829 prostatic lobes with biopsy-documented tumour were analysed. Overall, 142 lobes presented ECE that was focal in 27 (19%) cases. The classification tree identified four risk categories. In the low-[P (%) ≤10], intermediate-[P (%) 10-21], high [P (%) 21-73] and very-high-risk [P(%) >73] groups, the ECE rates were 3.3%, 16%, 61.6% and 90%, respectively. Amongst those, ECE was focal in 41.7%, 31.7%, 7.9% and 0%, respectively. ConclusionWe suggest that Grade 1 NS (intrafascial) should be performed in the low-risk group. The inter-fascial approach, namely grades 2 and 3 NS, should be performed in the intermediate-and high-risk categories, respectively. Grade 4 NS (extrafascial) should be performed in the very-high-risk group. The current algorithm yields a better accuracy than the previous one; however, prospective validation is warranted.

show abstract

“…Bradford et al have placed importance on minimizing traction and handling of tissue over any specific nerve-sparing technique employed, while multiple recent studies have also reported that a surgeon's own perception of nerve-sparing quality can be predictive of better potency outcomes [26, 27]. These studies highlight the subjectivity that arises from a surgeon's own interpretation of a successful nerve-sparing procedure, as well as the need for more objective measures.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy

et al. 2013

View full text Add to dashboard Cite

Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU) technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB) during robotic prostatectomy (RARP). Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56%) on the left and in 4 patients (44%) on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78%) patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.

show abstract

Cavernosal Nerve Preservation During Robot-assisted Radical Prostatectomy Is a Graded Rather Than an All-or-none Phenomenon: Objective Demonstration by Assessment of Residual Nerve Tissue on Surgical Specimens

Cited by 20 publications

References 17 publications

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

An updated approach to incremental nerve sparing for robot‐assisted radical prostatectomy

A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy

Contact Info

Product

Resources

About